title: Intravenous alteplase versus rescue endovascular procedure in patients with proximal middle cerebral artery occlusion.
abstract: OBJECTIVE
  To compare outcome of ischaemic stroke patients undergoing rescue endovascular procedure for proximal middle cerebral artery occlusion with matched patients without endovascular procedure after unsuccessful intravenous thrombolysis.
  
  
  METHODS
  Endovascularly treated patients with middle cerebral artery occlusion (n = 41) were matched by propensity score with similar patients treated by intravenous thrombolysis and having a considerable post-thrombolysis neurological deficit (n = 82). We compared their three-month outcome (modified Rankin Scale) and frequency of symptomatic intracerebral haemorrhage. For the endovascular group, we report onset-to-puncture time, onset-to-recanalization time, and recanalization rates.
  
  
  RESULTS
  In age, gender, time from onset, admission National Institutes of Health Stroke Scale, systolic and diastolic blood pressure, blood glucose, history of hypertension, diabetes mellitus, hyperlipidaemia, atrial fibrillation, and congestive heart failure, and in aetiology, the groups were similar. Endovascular group patients had a recanalization rate of 90%, and more often reached three-month modified Rankin Scale 0-2 (36.6% vs. 18.3%, P = 0.03). Mortality was equally common (19.5%) in both groups, and frequency of symptomatic intracerebral haemorrhage was 9.8% vs. 14.6% (P = 0.45). The endovascular group's median onset-to-puncture time was four-hours and six-minutes and onset-to-recanalization time was five-hours and 12 min. The latter time was more than one-hour longer in patients treated under general anaesthesia compared with patients treated under conscious sedation (median four-hours 50 min vs. five-hours 58 min; P < 0.01).
  
  
  CONCLUSIONS
  Rescue endovascular approach increases likelihood of recanalization and may improve functional outcome in acute ischaemic stroke patients with proximal middle cerebral artery occlusion who did not respond to intravenous thrombolysis.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.forename: Johanna
authors.initials: J
authors.lastname: Pekkola
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.forename: Elena
authors.initials: E
authors.lastname: Haapaniemi
authors.forename: Tapio
authors.initials: T
authors.lastname: Paananen
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Kimmo
authors.initials: K
authors.lastname: Lappalainen
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000628:therapy*; D008297:Male; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator