Intra-arterial reteplase compared to urokinase for thrombolytic recanalization in acute ischemic stroke

Rebecca M. Sugg, E. A. Noser, Hashem Shaltoni, N. R. Gonzales, M. S. Campbell, R. Weir, E. D. Cacayorin, J. C. Grotta

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Reteplase (RP) and urokinase (UK) are being used "off-label" to treat acute ischemic stroke. The safety and efficacy of intra-arterial RP or UK in the treatment of acute ischemic stroke, however, has yet to be proved. We aim to evaluate the safety and efficacy of RP compared with UK in acute ischemic stroke patients with large vessel occlusion. METHODS: Retrospective analysis was conducted of cases from a prospectively collected stroke data base on consecutive acute ischemic stroke patients with large vessel occlusion by digital subtraction angiography treated with intra-arterial RP or UK. Thrombolytic dosage, recanalization rate, intracerebral hemorrhage (ICH), mortality, and outcome were determined. RESULTS: Thirty-three patients received RP and 22 received UK (mean doses, 2.5 ± 1.4 mg and 690,000 ± 562,000 U, respectively). Vascular occlusions included 9 basilar arteries (BAs), 7 internal carotid arteries (ICAs), and 17 middle cerebral arteries (MCAs) with RP and 9 BAs, 4 ICAs, and 9 MCAs with UK. Median baseline National Institutes of Health Stroke Scales were as follows: 16 (range, 5-25; 81 % ≥ 10) with RP and 17 (range, 6-38; 85%≥10) with UK. Mean time from symptom onset to thrombolytic initiation: 333 ± 230 minutes with RP and 343 ± 169 minutes with UK. Recanalization rates were as follows: 82% with RP and 64% with UK (P = .13). Symptomatic ICH rates were as follows: 12% with RP and 4.5% with UK (P = .50). The mortality rate was 24% with RP and 27% with UK (P = .8). CONCLUSION: Although limited in statistical power, our study suggests that, although IA thrombolysis with RP shows a trend for higher recanalization rates and hemorrhage rates, IA thrombolysis with RP is not significantly different in recanalization, outcome, mortality, and ICH compared with that of UK or rates reported with IA pro-UK.

Original languageEnglish (US)
Pages (from-to)769-773
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume27
Issue number4
StatePublished - Apr 1 2006
Externally publishedYes

Fingerprint

Urokinase-Type Plasminogen Activator
Stroke
Cerebral Hemorrhage
Basilar Artery
saruplase
Middle Cerebral Artery
Internal Carotid Artery
reteplase
Mortality
Safety
Digital Subtraction Angiography
National Institutes of Health (U.S.)
Blood Vessels

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Sugg, R. M., Noser, E. A., Shaltoni, H., Gonzales, N. R., Campbell, M. S., Weir, R., ... Grotta, J. C. (2006). Intra-arterial reteplase compared to urokinase for thrombolytic recanalization in acute ischemic stroke. American Journal of Neuroradiology, 27(4), 769-773.

Intra-arterial reteplase compared to urokinase for thrombolytic recanalization in acute ischemic stroke. / Sugg, Rebecca M.; Noser, E. A.; Shaltoni, Hashem; Gonzales, N. R.; Campbell, M. S.; Weir, R.; Cacayorin, E. D.; Grotta, J. C.

In: American Journal of Neuroradiology, Vol. 27, No. 4, 01.04.2006, p. 769-773.

Research output: Contribution to journalArticle

Sugg, RM, Noser, EA, Shaltoni, H, Gonzales, NR, Campbell, MS, Weir, R, Cacayorin, ED & Grotta, JC 2006, 'Intra-arterial reteplase compared to urokinase for thrombolytic recanalization in acute ischemic stroke', American Journal of Neuroradiology, vol. 27, no. 4, pp. 769-773.
Sugg, Rebecca M. ; Noser, E. A. ; Shaltoni, Hashem ; Gonzales, N. R. ; Campbell, M. S. ; Weir, R. ; Cacayorin, E. D. ; Grotta, J. C. / Intra-arterial reteplase compared to urokinase for thrombolytic recanalization in acute ischemic stroke. In: American Journal of Neuroradiology. 2006 ; Vol. 27, No. 4. pp. 769-773.
@article{fef0c2887ac5460da909f351187dae48,
title = "Intra-arterial reteplase compared to urokinase for thrombolytic recanalization in acute ischemic stroke",
abstract = "BACKGROUND AND PURPOSE: Reteplase (RP) and urokinase (UK) are being used {"}off-label{"} to treat acute ischemic stroke. The safety and efficacy of intra-arterial RP or UK in the treatment of acute ischemic stroke, however, has yet to be proved. We aim to evaluate the safety and efficacy of RP compared with UK in acute ischemic stroke patients with large vessel occlusion. METHODS: Retrospective analysis was conducted of cases from a prospectively collected stroke data base on consecutive acute ischemic stroke patients with large vessel occlusion by digital subtraction angiography treated with intra-arterial RP or UK. Thrombolytic dosage, recanalization rate, intracerebral hemorrhage (ICH), mortality, and outcome were determined. RESULTS: Thirty-three patients received RP and 22 received UK (mean doses, 2.5 ± 1.4 mg and 690,000 ± 562,000 U, respectively). Vascular occlusions included 9 basilar arteries (BAs), 7 internal carotid arteries (ICAs), and 17 middle cerebral arteries (MCAs) with RP and 9 BAs, 4 ICAs, and 9 MCAs with UK. Median baseline National Institutes of Health Stroke Scales were as follows: 16 (range, 5-25; 81 {\%} ≥ 10) with RP and 17 (range, 6-38; 85{\%}≥10) with UK. Mean time from symptom onset to thrombolytic initiation: 333 ± 230 minutes with RP and 343 ± 169 minutes with UK. Recanalization rates were as follows: 82{\%} with RP and 64{\%} with UK (P = .13). Symptomatic ICH rates were as follows: 12{\%} with RP and 4.5{\%} with UK (P = .50). The mortality rate was 24{\%} with RP and 27{\%} with UK (P = .8). CONCLUSION: Although limited in statistical power, our study suggests that, although IA thrombolysis with RP shows a trend for higher recanalization rates and hemorrhage rates, IA thrombolysis with RP is not significantly different in recanalization, outcome, mortality, and ICH compared with that of UK or rates reported with IA pro-UK.",
author = "Sugg, {Rebecca M.} and Noser, {E. A.} and Hashem Shaltoni and Gonzales, {N. R.} and Campbell, {M. S.} and R. Weir and Cacayorin, {E. D.} and Grotta, {J. C.}",
year = "2006",
month = "4",
day = "1",
language = "English (US)",
volume = "27",
pages = "769--773",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "4",

}

TY - JOUR

T1 - Intra-arterial reteplase compared to urokinase for thrombolytic recanalization in acute ischemic stroke

AU - Sugg, Rebecca M.

AU - Noser, E. A.

AU - Shaltoni, Hashem

AU - Gonzales, N. R.

AU - Campbell, M. S.

AU - Weir, R.

AU - Cacayorin, E. D.

AU - Grotta, J. C.

PY - 2006/4/1

Y1 - 2006/4/1

N2 - BACKGROUND AND PURPOSE: Reteplase (RP) and urokinase (UK) are being used "off-label" to treat acute ischemic stroke. The safety and efficacy of intra-arterial RP or UK in the treatment of acute ischemic stroke, however, has yet to be proved. We aim to evaluate the safety and efficacy of RP compared with UK in acute ischemic stroke patients with large vessel occlusion. METHODS: Retrospective analysis was conducted of cases from a prospectively collected stroke data base on consecutive acute ischemic stroke patients with large vessel occlusion by digital subtraction angiography treated with intra-arterial RP or UK. Thrombolytic dosage, recanalization rate, intracerebral hemorrhage (ICH), mortality, and outcome were determined. RESULTS: Thirty-three patients received RP and 22 received UK (mean doses, 2.5 ± 1.4 mg and 690,000 ± 562,000 U, respectively). Vascular occlusions included 9 basilar arteries (BAs), 7 internal carotid arteries (ICAs), and 17 middle cerebral arteries (MCAs) with RP and 9 BAs, 4 ICAs, and 9 MCAs with UK. Median baseline National Institutes of Health Stroke Scales were as follows: 16 (range, 5-25; 81 % ≥ 10) with RP and 17 (range, 6-38; 85%≥10) with UK. Mean time from symptom onset to thrombolytic initiation: 333 ± 230 minutes with RP and 343 ± 169 minutes with UK. Recanalization rates were as follows: 82% with RP and 64% with UK (P = .13). Symptomatic ICH rates were as follows: 12% with RP and 4.5% with UK (P = .50). The mortality rate was 24% with RP and 27% with UK (P = .8). CONCLUSION: Although limited in statistical power, our study suggests that, although IA thrombolysis with RP shows a trend for higher recanalization rates and hemorrhage rates, IA thrombolysis with RP is not significantly different in recanalization, outcome, mortality, and ICH compared with that of UK or rates reported with IA pro-UK.

AB - BACKGROUND AND PURPOSE: Reteplase (RP) and urokinase (UK) are being used "off-label" to treat acute ischemic stroke. The safety and efficacy of intra-arterial RP or UK in the treatment of acute ischemic stroke, however, has yet to be proved. We aim to evaluate the safety and efficacy of RP compared with UK in acute ischemic stroke patients with large vessel occlusion. METHODS: Retrospective analysis was conducted of cases from a prospectively collected stroke data base on consecutive acute ischemic stroke patients with large vessel occlusion by digital subtraction angiography treated with intra-arterial RP or UK. Thrombolytic dosage, recanalization rate, intracerebral hemorrhage (ICH), mortality, and outcome were determined. RESULTS: Thirty-three patients received RP and 22 received UK (mean doses, 2.5 ± 1.4 mg and 690,000 ± 562,000 U, respectively). Vascular occlusions included 9 basilar arteries (BAs), 7 internal carotid arteries (ICAs), and 17 middle cerebral arteries (MCAs) with RP and 9 BAs, 4 ICAs, and 9 MCAs with UK. Median baseline National Institutes of Health Stroke Scales were as follows: 16 (range, 5-25; 81 % ≥ 10) with RP and 17 (range, 6-38; 85%≥10) with UK. Mean time from symptom onset to thrombolytic initiation: 333 ± 230 minutes with RP and 343 ± 169 minutes with UK. Recanalization rates were as follows: 82% with RP and 64% with UK (P = .13). Symptomatic ICH rates were as follows: 12% with RP and 4.5% with UK (P = .50). The mortality rate was 24% with RP and 27% with UK (P = .8). CONCLUSION: Although limited in statistical power, our study suggests that, although IA thrombolysis with RP shows a trend for higher recanalization rates and hemorrhage rates, IA thrombolysis with RP is not significantly different in recanalization, outcome, mortality, and ICH compared with that of UK or rates reported with IA pro-UK.

UR - http://www.scopus.com/inward/record.url?scp=33748062684&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748062684&partnerID=8YFLogxK

M3 - Article

C2 - 16611762

AN - SCOPUS:33748062684

VL - 27

SP - 769

EP - 773

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

IS - 4

ER -