Mechanical disruption of thrombus following intravenous tissue plasminogen activator for ischemic stroke.
OBJECTIVE
We prospectively evaluated the safety of aggressive mechanical disruption of thrombus following full-dose intravenous (IV) recombinant tissue plasminogen activator (rt-PA) to treat ischemic stroke in 24 patients with an initial National Institutes of Health stroke scale (NIHSS) score of >or=10.


METHODS
Clinical evaluations were performed at presentation and 24 hours, 7 to 10 days, and 1 to 3 months (using modified Rankin scale) after treatment. These end points were compared to matched historical controls treated with IV rt-PA alone.


RESULTS
Of the 24 patients, mechanical disruption was undertaken in 17 patients with persistent angiographic occlusion using microcatheter exploration (n= 3), angioplasty (n= 5), snare maneuvers (n= 7), and combination of both (n= 2). Partial or complete recanalization was observed in 10 of the 17 patients. Neurological improvement at 24 hours (>or=4 point reduction in NIHSS score) was observed in 11 of 17 patients. Comparisons with matched controls suggest potential equivalence for symptomatic ICH (0% vs 12%), asymptomatic ICH (18% vs 15%), and early neurological improvement (65% vs 53%).


CONCLUSIONS
The study shows that aggressive mechanical thrombus disruption in large artery occlusion in the setting of acute ischemic stroke is safe with acceptable rates of ICH and promotes angiographic recanalization.
Qureshi
Adnan I
AI
Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA. aiqureshi@hotmail.com
Janjua
Nazli
N
Kirmani
Jawad F
JF
Harris-Lane
Pansy
P
Suri
M Fareed K
MF
Zhou
Jingying
J
Divani
Afshin A
AA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D020767:Intracranial Thrombosis / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator