Early outcome of combined thrombolysis based on the mismatch on perfusion CT.
BACKGROUND
Possible factors associated with early outcome after thrombolysis are the recanalization time and the status of tissue. We assessed whether combined intravenous (IV) and intra-arterial (IA) thrombolysis performed according to the status of tissue based on perfusion computed tomography (PCT) is beneficial for the early outcome in patients with acute ischemic stroke.


METHODS
To improve the recanalization time, we assumed that combined IA thrombolysis after IV thrombolysis would be beneficial. Eligible patients for combined thrombolysis were selected according to the status of tissue based on PCT. Recanalization was defined as Thrombolysis in Myocardial Infarction (TIMI) grade 2 or 3. 'Good functional outcome' was defined as a Modified Rankin Scale (mRS) score of 2 or less at discharge.


RESULTS
Eighteen patients (11 men) underwent combined IV/IA thrombolysis. The recanalization rate after combined IV/IA thrombolysis was 88.9% (TIMI 2, 4; TIMI 3, 12). A good functional outcome at discharge was noted in 12 patients (66.7%). The incidence of symptomatic intracranial hemorrhage was 5.6% (1/18).


CONCLUSIONS
The results of this study suggest that combined IV/IA thrombolysis based on the presence of mismatches on PCT might have a relatively high rate of recanalization and a favorable early outcome. In addition, the incidence of symptomatic intracranial hemorrhage was acceptable.
Kim
Joon-Tae
JT
Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
Yoon
Woong
W
Park
Man-Seok
MS
Nam
Tai-Seung
TS
Choi
Seong-Min
SM
Lee
Seung-Han
SH
Kim
Byeong-Chae
BC
Kim
Myeong-Kyu
MK
Cho
Ki-Hyun
KH
D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator