Therapeutic results of intra-arterial thrombolysis after full-dose intravenous tissue plasminogen activator administration.
OBJECTIVE
IV administration of tPA is accepted as a standard treatment for acute cerebral ischemia, but the clinical outcomes cannot be guaranteed in patients who are not recanalized after IV-tPA and in those who are not eligible for IV-tPA. In this study, outcomes from groups of patients treated with additional IA thrombolytic therapy with the use or omission of IV-tPA administration were compared.


METHODS
IA thrombolytic therapy (thrombolytic agents combined with mechanical intervention) was attempted in those patients who were not eligible for IV-tPA and who showed continuous major vessel occlusion after IV-tPA. Sixty-three patients were divided into 2 groups: a tPA group (n = 29, IA thrombolysis after IV-tPA) and a non-tPA group (n = 34, IA thrombolysis without IV-tPA). These groups were subdivided according to match or mismatch DWI/PWI after MR imaging. Treatment results were compared by recanalization rate, clinical outcome, mortality, and ICH rate.


RESULTS
The recanalization rate was 79.3% in the tPA group and 55.9% in the non-tPA group (χ(2) test, P < .05). Subgroup analysis between DWI/PWI mismatch in the tPA group and DWI/PWI mismatch in the non-tPA group also showed no statistical difference in recanalization rate, favorable clinical outcome, and mortality (χ(2) test, P > .05), but the significant ICH rate was high in the tPA group (χ(2) test, P < .05).


CONCLUSIONS
Additional IA thrombolytic treatment after full-dose IV-tPA administration might be an acceptable treatment option for patients with DWI/PWI mismatch.
Yoo
D-S
DS
Department of Neurosurgery, St. Mary's Hospital, Uijeongbu, South Korea. yooman@catholic.ac.kr
Won
Y-D
YD
Huh
P-W
PW
Shin
H-E
HE
Kim
K-T
KT
Kang
S-G
SG
Lee
S-B
SB
Cho
K-S
KS
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy* / Q000473:pathology; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
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