Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions

Syed F. Zaidi, Alicia C. Castonguay, Mouhammad A. Jumaa, Tim W. Malisch, Italo Linfante, Franklin A. Marden, Michael G. Abraham, Alex Bou Chebl, Roberta Novakovic, M. Asif Taqi, Raul G. Nogueira, Coleman O. Martin, William E. Holloway, Nils Mueller-Kronast, Joey D. English, Guilherme Dabus, Hormozd Bozorgchami, Andrew Xavier, Ansaar T. Rai, Michael T. Froehler & 11 others Aamir Badruddin, Thanh N. Nguyen, Albert J. Yoo, Hashem Shaltoni, Vallabh Janardhan, Peng R. Chen, Gavin W. Britz, Ritesh Kaushal, Ashish Nanda, Rishi Gupta, Osama O. Zaidat

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Purpose- Mechanical thrombectomy (MT) devices have led to improved reperfusion and clinical outcomes in acute ischemic stroke patients with emergent large vessel occlusions; however, less than one-third of patients achieve complete reperfusion. Use of intraarterial thrombolysis in the context of MT may provide an opportunity to enhance these results. Here, we evaluate the use of intraarterial rtPA (recombinant tissue-type plasminogen activator) as rescue therapy (RT) after failed MT in the North American Solitaire Stent-Retriever Acute Stroke registry. Methods- The North American Solitaire Stent-Retriever Acute Stroke registry recruited sites within North America to submit data on acute ischemic stroke patients treated with the Solitaire device. After restricting the population of 354 patients to use of RT and anterior emergent large vessel occlusions, we compared patients who were treated with and without intraarterial rtPA after failed MT. Results- A total of 37 and 44 patients was in the intraarterial rtPA RT and the no intraarterial rtPA RT groups, respectively. Revascularization success (modified Thrombolysis in Cerebral Infarction ≥2b) was achieved in more intraarterial rtPA RT patients (61.2% versus 46.6%; P=0.13) with faster times to recanalization (100±85 versus 164±235 minutes; P=0.36) but was not statistically significant. The rate of symptomatic intracranial hemorrhage (13.9% versus 6.8%; P=0.29) and mortality (42.9% versus 44.7%; P=0.87) were similar between the groups. Good functional outcome (modified Rankin Scale score of ≤2) was numerically higher in intraarterial rtPA patients (22.9% versus 18.4%; P=0.64). Further restriction of the RT population to M1 occlusions only and time of onset to groin puncture ≤8 hours, resulted in significantly higher successful revascularization rates in the intraarterial rtPA RT cohort (77.8% versus 38.9%; P=0.02). Conclusions- Intraarterial rtPA as RT demonstrated a similar safety and clinical outcome profile, with higher reperfusion rates achieved in patients with M1 occlusions. Prospective studies are needed to delineate the role of intraarterial thrombolysis in MT.

Original languageEnglish (US)
Pages (from-to)1003-1006
Number of pages4
JournalStroke
Volume50
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Tissue Plasminogen Activator
Thrombectomy
Stroke
Reperfusion
Therapeutics
Stents
Registries
Mechanical Thrombolysis
Equipment and Supplies
Groin
Intracranial Hemorrhages
Cerebral Infarction
Group Psychotherapy
North America
Punctures
Population
Prospective Studies
Safety
Mortality

Keywords

  • occlusion
  • reperfusion
  • standard of care
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Zaidi, S. F., Castonguay, A. C., Jumaa, M. A., Malisch, T. W., Linfante, I., Marden, F. A., ... Zaidat, O. O. (2019). Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions. Stroke, 50(4), 1003-1006. https://doi.org/10.1161/STROKEAHA.118.024442

Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions. / Zaidi, Syed F.; Castonguay, Alicia C.; Jumaa, Mouhammad A.; Malisch, Tim W.; Linfante, Italo; Marden, Franklin A.; Abraham, Michael G.; Chebl, Alex Bou; Novakovic, Roberta; Taqi, M. Asif; Nogueira, Raul G.; Martin, Coleman O.; Holloway, William E.; Mueller-Kronast, Nils; English, Joey D.; Dabus, Guilherme; Bozorgchami, Hormozd; Xavier, Andrew; Rai, Ansaar T.; Froehler, Michael T.; Badruddin, Aamir; Nguyen, Thanh N.; Yoo, Albert J.; Shaltoni, Hashem; Janardhan, Vallabh; Chen, Peng R.; Britz, Gavin W.; Kaushal, Ritesh; Nanda, Ashish; Gupta, Rishi; Zaidat, Osama O.

In: Stroke, Vol. 50, No. 4, 01.04.2019, p. 1003-1006.

Research output: Contribution to journalArticle

Zaidi, SF, Castonguay, AC, Jumaa, MA, Malisch, TW, Linfante, I, Marden, FA, Abraham, MG, Chebl, AB, Novakovic, R, Taqi, MA, Nogueira, RG, Martin, CO, Holloway, WE, Mueller-Kronast, N, English, JD, Dabus, G, Bozorgchami, H, Xavier, A, Rai, AT, Froehler, MT, Badruddin, A, Nguyen, TN, Yoo, AJ, Shaltoni, H, Janardhan, V, Chen, PR, Britz, GW, Kaushal, R, Nanda, A, Gupta, R & Zaidat, OO 2019, 'Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions', Stroke, vol. 50, no. 4, pp. 1003-1006. https://doi.org/10.1161/STROKEAHA.118.024442
Zaidi SF, Castonguay AC, Jumaa MA, Malisch TW, Linfante I, Marden FA et al. Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions. Stroke. 2019 Apr 1;50(4):1003-1006. https://doi.org/10.1161/STROKEAHA.118.024442
Zaidi, Syed F. ; Castonguay, Alicia C. ; Jumaa, Mouhammad A. ; Malisch, Tim W. ; Linfante, Italo ; Marden, Franklin A. ; Abraham, Michael G. ; Chebl, Alex Bou ; Novakovic, Roberta ; Taqi, M. Asif ; Nogueira, Raul G. ; Martin, Coleman O. ; Holloway, William E. ; Mueller-Kronast, Nils ; English, Joey D. ; Dabus, Guilherme ; Bozorgchami, Hormozd ; Xavier, Andrew ; Rai, Ansaar T. ; Froehler, Michael T. ; Badruddin, Aamir ; Nguyen, Thanh N. ; Yoo, Albert J. ; Shaltoni, Hashem ; Janardhan, Vallabh ; Chen, Peng R. ; Britz, Gavin W. ; Kaushal, Ritesh ; Nanda, Ashish ; Gupta, Rishi ; Zaidat, Osama O. / Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions. In: Stroke. 2019 ; Vol. 50, No. 4. pp. 1003-1006.
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TY - JOUR

T1 - Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions

AU - Zaidi, Syed F.

AU - Castonguay, Alicia C.

AU - Jumaa, Mouhammad A.

AU - Malisch, Tim W.

AU - Linfante, Italo

AU - Marden, Franklin A.

AU - Abraham, Michael G.

AU - Chebl, Alex Bou

AU - Novakovic, Roberta

AU - Taqi, M. Asif

AU - Nogueira, Raul G.

AU - Martin, Coleman O.

AU - Holloway, William E.

AU - Mueller-Kronast, Nils

AU - English, Joey D.

AU - Dabus, Guilherme

AU - Bozorgchami, Hormozd

AU - Xavier, Andrew

AU - Rai, Ansaar T.

AU - Froehler, Michael T.

AU - Badruddin, Aamir

AU - Nguyen, Thanh N.

AU - Yoo, Albert J.

AU - Shaltoni, Hashem

AU - Janardhan, Vallabh

AU - Chen, Peng R.

AU - Britz, Gavin W.

AU - Kaushal, Ritesh

AU - Nanda, Ashish

AU - Gupta, Rishi

AU - Zaidat, Osama O.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background and Purpose- Mechanical thrombectomy (MT) devices have led to improved reperfusion and clinical outcomes in acute ischemic stroke patients with emergent large vessel occlusions; however, less than one-third of patients achieve complete reperfusion. Use of intraarterial thrombolysis in the context of MT may provide an opportunity to enhance these results. Here, we evaluate the use of intraarterial rtPA (recombinant tissue-type plasminogen activator) as rescue therapy (RT) after failed MT in the North American Solitaire Stent-Retriever Acute Stroke registry. Methods- The North American Solitaire Stent-Retriever Acute Stroke registry recruited sites within North America to submit data on acute ischemic stroke patients treated with the Solitaire device. After restricting the population of 354 patients to use of RT and anterior emergent large vessel occlusions, we compared patients who were treated with and without intraarterial rtPA after failed MT. Results- A total of 37 and 44 patients was in the intraarterial rtPA RT and the no intraarterial rtPA RT groups, respectively. Revascularization success (modified Thrombolysis in Cerebral Infarction ≥2b) was achieved in more intraarterial rtPA RT patients (61.2% versus 46.6%; P=0.13) with faster times to recanalization (100±85 versus 164±235 minutes; P=0.36) but was not statistically significant. The rate of symptomatic intracranial hemorrhage (13.9% versus 6.8%; P=0.29) and mortality (42.9% versus 44.7%; P=0.87) were similar between the groups. Good functional outcome (modified Rankin Scale score of ≤2) was numerically higher in intraarterial rtPA patients (22.9% versus 18.4%; P=0.64). Further restriction of the RT population to M1 occlusions only and time of onset to groin puncture ≤8 hours, resulted in significantly higher successful revascularization rates in the intraarterial rtPA RT cohort (77.8% versus 38.9%; P=0.02). Conclusions- Intraarterial rtPA as RT demonstrated a similar safety and clinical outcome profile, with higher reperfusion rates achieved in patients with M1 occlusions. Prospective studies are needed to delineate the role of intraarterial thrombolysis in MT.

AB - Background and Purpose- Mechanical thrombectomy (MT) devices have led to improved reperfusion and clinical outcomes in acute ischemic stroke patients with emergent large vessel occlusions; however, less than one-third of patients achieve complete reperfusion. Use of intraarterial thrombolysis in the context of MT may provide an opportunity to enhance these results. Here, we evaluate the use of intraarterial rtPA (recombinant tissue-type plasminogen activator) as rescue therapy (RT) after failed MT in the North American Solitaire Stent-Retriever Acute Stroke registry. Methods- The North American Solitaire Stent-Retriever Acute Stroke registry recruited sites within North America to submit data on acute ischemic stroke patients treated with the Solitaire device. After restricting the population of 354 patients to use of RT and anterior emergent large vessel occlusions, we compared patients who were treated with and without intraarterial rtPA after failed MT. Results- A total of 37 and 44 patients was in the intraarterial rtPA RT and the no intraarterial rtPA RT groups, respectively. Revascularization success (modified Thrombolysis in Cerebral Infarction ≥2b) was achieved in more intraarterial rtPA RT patients (61.2% versus 46.6%; P=0.13) with faster times to recanalization (100±85 versus 164±235 minutes; P=0.36) but was not statistically significant. The rate of symptomatic intracranial hemorrhage (13.9% versus 6.8%; P=0.29) and mortality (42.9% versus 44.7%; P=0.87) were similar between the groups. Good functional outcome (modified Rankin Scale score of ≤2) was numerically higher in intraarterial rtPA patients (22.9% versus 18.4%; P=0.64). Further restriction of the RT population to M1 occlusions only and time of onset to groin puncture ≤8 hours, resulted in significantly higher successful revascularization rates in the intraarterial rtPA RT cohort (77.8% versus 38.9%; P=0.02). Conclusions- Intraarterial rtPA as RT demonstrated a similar safety and clinical outcome profile, with higher reperfusion rates achieved in patients with M1 occlusions. Prospective studies are needed to delineate the role of intraarterial thrombolysis in MT.

KW - occlusion

KW - reperfusion

KW - standard of care

KW - stroke

KW - thrombectomy

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