title: Intra-Arterial Thrombolysis after Full-Dose Intravenous tPA via the "Drip and Ship" Approach in Patients with Acute Ischemic Stroke: Preliminary Report.
abstract: According to the "drip and ship" concept, patients who are not responsive to intravenous tissue plasminogen activator (IV-tPA) at a community hospital may be candidates for subsequent intra-arterial (IA) thrombolysis at a comprehensive stroke center. We elucidated the efficacy and safety of combined IV/IA thrombolysis via the drip and ship approach. We retrospectively reviewed patients with acute ischemic stroke who underwent combined IV/IA thrombolysis between March 2006 and June 2009. The patients were divided into two groups (inside hospital IV-tPA vs. outside hospital IV-tPA). We compared the short- and long-term clinical outcome, recanalization rate, intracranial hemorrhage after the procedure, and onset to treatment time between the two groups. A total of 23 patients with inside hospital IV-tPA and 10 patients with outside hospital IV-tPA were included. The mean pre-treatment National Institutes of Health Stroke Scale (NIHSS) scores were 15.8 and 17.5, respectively. Baseline characteristics were not significantly different between the two groups. The NIHSS score at 1 week and favorable outcome rate (modified Rankin Scale ≤2) 3 months after the procedure were not significantly different (p=0.730 and p=0.141, respectively). The rate of recanalization and intracranial hemorrhage were not significantly different (p=0.560 and p=0.730, respectively). The onset to IA thrombolysis time was also not significantly different (222.7 vs. 239.3 minutes, p=0.455). Our results suggest that initiation of IV-tPA in a community hospital with rapid transfer to a comprehensive stroke center for subsequent IA thrombolysis can be a safe and feasible therapeutic option in acute stroke management.
authors: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
authors: Man-Seok
authors: MS
authors: Park
authors: Joon-Tae
authors: JT
authors: Kim
authors: Woong
authors: W
authors: Yoon
authors: Jae-Kyu
authors: JK
authors: Kim
authors: Byeong-Chae
authors: BC
authors: Kim
authors: Seung-Han
authors: SH
authors: Lee
authors: Seong-Min
authors: SM
authors: Choi
authors: Kang-Ho
authors: KH
authors: Choi
authors: Tae-Seung
authors: TS
authors: Nam
authors: Myeong-Kyu
authors: MK
authors: Kim
authors: Ki-Hyun
authors: KH
authors: Cho