title: Reasons to withhold intra-arterial thrombolysis in clinical practice.
abstract: BACKGROUND
  In selected stroke centers intra-arterial thrombolysis (IAT) is used for the treatment of acute stroke patients presenting within 6 hours of symptom onset. However, data about eligibility of acute stroke patients for IAT in clinical practice are very scarce.
  
  
  METHODS
  We collected prospectively data on indications advising for or against IAT of 230 consecutive stroke patients in a tertiary stroke center.
  
  
  RESULTS
  76 patients (33.0%) presented within 3 hours, 69 (30%) between 3 and 6 hours of symptom onset and 85 (37%) later than 6 hours. Arteriography was performed in 71 patients (31%) and IAT in 46 (20%). In 11 patients no or only peripheral branch occlusions were seen on arteriography and therefore IAT was not performed. In 9 patients the ICA was occluded and barred IAT and in five anatomical or technical difficulties made IAT impossible. 72 patients presenting within 6 hours did not undergo arteriography and thrombolysis, mostly because of mild (n=44) or rapidly improving neurological deficits (n=13). Other reasons to withhold IAT were CT and/or clinical findings suggesting lacunar stroke due to small vessel occlusion (n=7), limiting comorbidty (n=7) and baseline international normalized ratio>1.7 (n=1).
  
  
  CONCLUSIONS
  A third of the patients underwent diagnostic arteriography and one fifth received IAT. The most important reasons to withhold thrombolysis were presentation beyond the 6 hours time window and mild or rapidly improving symptoms.
authors.affiliation: Department of Internal Medicine, University of Bern, Inselspital, Bern, 3010, Bern, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Isenegger
authors.forename: K
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: U
authors.initials: U
authors.lastname: Fischer
authors.forename: G
authors.initials: G
authors.lastname: Schroth
authors.forename: L
authors.initials: L
authors.lastname: Remonda
authors.forename: H P
authors.initials: HP
authors.lastname: Mattle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents