Comparison of combined venous and arterial thrombolysis with primary arterial therapy using recombinant tissue plasminogen activator in acute ischemic stroke. J Stroke Cerebrovasc Dis 2008;17(3):121-8
Date
04/26/2008Pubmed ID
18436152DOI
10.1016/j.jstrokecerebrovasdis.2007.12.004Scopus ID
2-s2.0-43049118612 (requires institutional sign-in at Scopus site) 38 CitationsAbstract
OBJECTIVE: We sought to compare the safety and efficacy of combined intravenous (IV) and intra-arterial (IA) thrombolysis with primary IA therapy using tissue plasminogen activator for acute ischemic stroke presenting within 6 hours of symptom onset.
METHODS: We performed quasirandomization of a single institution's prospectively collected stroke database, comparing IV/IA (0.6 mg/kg IV < or = 60 mg, followed by 0.3 mg/kg IA < or = 30 mg) versus primary IA. Outcome measures include 90-day modified Rankin scale score, mortality, symptomatic intracerebral hemorrhage, and recanalization rates. Statistical analysis was performed using bivariate and propensity score methods.
RESULTS: Of 1057 patients, 41 patients were treated with IV/IA, and 55 with IA. There was significant difference in time to treatment (mean of 151 minutes for the combined group and 261 minutes for the IA, P < .0001) and arterial tissue plasminogen activator dose (17.5 mg for IV/IA v 22.8 mg for IA only, P = .05). Propensity score matching yielded 25 patients in each group. Symptomatic intracerebral hemorrhage rate was 12% in each group. Mortality was 20% in the IV/IA group versus 16% in the IA group (relative risk 1.3 [0.4-4.1], P = .7). More patients in IV/IA group had modified Rankin scale score less than or equal to 2 (odds ratio 1.6 [0.5-5.8], P = .3). Recanalization was 64% with IV/IA versus 48% with IA (odds ratio 1.9 [0.5-7.0], P = .3).
CONCLUSION: This study demonstrates that both combined IV/IA and primary IA recombinant tissue plasminogen activator therapy is feasible and safe in the treatment of acute ischemic stroke. Combined IV/IA therapy may be associated with an improvement in clinical outcome without a significant increase in the risk of symptomatic intracerebral hemorrhage and mortality compared with IA therapy.
Author List
Wolfe T, Suarez JI, Tarr RW, Welter E, Landis D, Sunshine JL, Zaidat OOMESH terms used to index this publication - Major topics in bold
Acute DiseaseAdult
Aged
Aged, 80 and over
Brain Ischemia
Cerebral Hemorrhage
Databases, Factual
Drug Administration Schedule
Feasibility Studies
Female
Fibrinolytic Agents
Humans
Infusions, Intra-Arterial
Infusions, Intravenous
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Prospective Studies
Recombinant Proteins
Risk Assessment
Stroke
Thrombolytic Therapy
Time Factors
Tissue Plasminogen Activator
Treatment Outcome