Is intra-arterial thrombolysis safe after full-dose intravenous recombinant tissue plasminogen activator for acute ischemic stroke?

Hashem Shaltoni, Karen C. Albright, Nicole R. Gonzales, Raymond U. Weir, Aslam M. Khaja, Rebecca M. Sugg, Morgan S. Campbell, Edwin D. Cacayorin, James C. Grotta, Elizabeth A. Noser

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - The optimal approach for acute ischemic stroke patients who do not respond to intravenous recombinant tissue plasminogen activator (IV rt-PA) is uncertain. This study evaluated the safety and response to intra-arterial thrombolytics (IATs) in patients unresponsive to full-dose IV rt-PA. METHODS - A case series from a prospectively collected database on consecutive acute ischemic stroke patients treated with IATs after 0.9 mg/kg IV rt-PA during a 7-year interval was collected. Primary outcome measures included symptomatic intracranial hemorrhage and mortality. As indicators of response, secondary outcome measures were recanalization and discharge disposition. RESULTS - Sixty-nine patients (mean±SD age, 60±13 years; range, 26 to 85 years; 55% male) with a median pretreatment National Institutes of Health Stroke Scale score of 18 (range, 6 to 39) were included. IV rt-PA was started at 124±32 minutes (median, 120 minutes) and IAT, at 288±57 minutes (median, 285 minutes). IATs consisted of reteplase (n=56), alteplase (n=7), and urokinase (n=6), with an average total dosage of 2.8 U, 8.6 mg, and 700 000 U, respectively. Symptomatic intracranial hemorrhage occurred in 4 of 69 (5.8%) patients; 3 cases were fatal. Recanalization was achieved in 50 (72.5%) and a favorable outcome (home or inpatient rehabilitation) in 38 (55%). CONCLUSIONS - IAT therapy after full-dose IV rt-PA in patients with persisting occlusion and/or lack of clinical improvement appears safe compared with IV rt-PA alone or low-dose IV rt-PA followed by IAT. A high rate of recanalization and favorable outcome can be achieved.

Original languageEnglish (US)
Pages (from-to)80-84
Number of pages5
JournalStroke
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

Fingerprint

Tissue Plasminogen Activator
Stroke
Intracranial Hemorrhages
Outcome Assessment (Health Care)
Thrombolytic Therapy
Urokinase-Type Plasminogen Activator
National Institutes of Health (U.S.)
Inpatients
Rehabilitation
Databases
Safety
Mortality

Keywords

  • Acute stroke
  • Endovascular treatment
  • Intracranial hemorrhage
  • t-PA
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Is intra-arterial thrombolysis safe after full-dose intravenous recombinant tissue plasminogen activator for acute ischemic stroke? / Shaltoni, Hashem; Albright, Karen C.; Gonzales, Nicole R.; Weir, Raymond U.; Khaja, Aslam M.; Sugg, Rebecca M.; Campbell, Morgan S.; Cacayorin, Edwin D.; Grotta, James C.; Noser, Elizabeth A.

In: Stroke, Vol. 38, No. 1, 01.01.2007, p. 80-84.

Research output: Contribution to journalArticle

Shaltoni, H, Albright, KC, Gonzales, NR, Weir, RU, Khaja, AM, Sugg, RM, Campbell, MS, Cacayorin, ED, Grotta, JC & Noser, EA 2007, 'Is intra-arterial thrombolysis safe after full-dose intravenous recombinant tissue plasminogen activator for acute ischemic stroke?', Stroke, vol. 38, no. 1, pp. 80-84. https://doi.org/10.1161/01.STR.0000251720.25337.b0
Shaltoni, Hashem ; Albright, Karen C. ; Gonzales, Nicole R. ; Weir, Raymond U. ; Khaja, Aslam M. ; Sugg, Rebecca M. ; Campbell, Morgan S. ; Cacayorin, Edwin D. ; Grotta, James C. ; Noser, Elizabeth A. / Is intra-arterial thrombolysis safe after full-dose intravenous recombinant tissue plasminogen activator for acute ischemic stroke?. In: Stroke. 2007 ; Vol. 38, No. 1. pp. 80-84.
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abstract = "BACKGROUND AND PURPOSE - The optimal approach for acute ischemic stroke patients who do not respond to intravenous recombinant tissue plasminogen activator (IV rt-PA) is uncertain. This study evaluated the safety and response to intra-arterial thrombolytics (IATs) in patients unresponsive to full-dose IV rt-PA. METHODS - A case series from a prospectively collected database on consecutive acute ischemic stroke patients treated with IATs after 0.9 mg/kg IV rt-PA during a 7-year interval was collected. Primary outcome measures included symptomatic intracranial hemorrhage and mortality. As indicators of response, secondary outcome measures were recanalization and discharge disposition. RESULTS - Sixty-nine patients (mean±SD age, 60±13 years; range, 26 to 85 years; 55{\%} male) with a median pretreatment National Institutes of Health Stroke Scale score of 18 (range, 6 to 39) were included. IV rt-PA was started at 124±32 minutes (median, 120 minutes) and IAT, at 288±57 minutes (median, 285 minutes). IATs consisted of reteplase (n=56), alteplase (n=7), and urokinase (n=6), with an average total dosage of 2.8 U, 8.6 mg, and 700 000 U, respectively. Symptomatic intracranial hemorrhage occurred in 4 of 69 (5.8{\%}) patients; 3 cases were fatal. Recanalization was achieved in 50 (72.5{\%}) and a favorable outcome (home or inpatient rehabilitation) in 38 (55{\%}). CONCLUSIONS - IAT therapy after full-dose IV rt-PA in patients with persisting occlusion and/or lack of clinical improvement appears safe compared with IV rt-PA alone or low-dose IV rt-PA followed by IAT. A high rate of recanalization and favorable outcome can be achieved.",
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AU - Shaltoni, Hashem

AU - Albright, Karen C.

AU - Gonzales, Nicole R.

AU - Weir, Raymond U.

AU - Khaja, Aslam M.

AU - Sugg, Rebecca M.

AU - Campbell, Morgan S.

AU - Cacayorin, Edwin D.

AU - Grotta, James C.

AU - Noser, Elizabeth A.

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N2 - BACKGROUND AND PURPOSE - The optimal approach for acute ischemic stroke patients who do not respond to intravenous recombinant tissue plasminogen activator (IV rt-PA) is uncertain. This study evaluated the safety and response to intra-arterial thrombolytics (IATs) in patients unresponsive to full-dose IV rt-PA. METHODS - A case series from a prospectively collected database on consecutive acute ischemic stroke patients treated with IATs after 0.9 mg/kg IV rt-PA during a 7-year interval was collected. Primary outcome measures included symptomatic intracranial hemorrhage and mortality. As indicators of response, secondary outcome measures were recanalization and discharge disposition. RESULTS - Sixty-nine patients (mean±SD age, 60±13 years; range, 26 to 85 years; 55% male) with a median pretreatment National Institutes of Health Stroke Scale score of 18 (range, 6 to 39) were included. IV rt-PA was started at 124±32 minutes (median, 120 minutes) and IAT, at 288±57 minutes (median, 285 minutes). IATs consisted of reteplase (n=56), alteplase (n=7), and urokinase (n=6), with an average total dosage of 2.8 U, 8.6 mg, and 700 000 U, respectively. Symptomatic intracranial hemorrhage occurred in 4 of 69 (5.8%) patients; 3 cases were fatal. Recanalization was achieved in 50 (72.5%) and a favorable outcome (home or inpatient rehabilitation) in 38 (55%). CONCLUSIONS - IAT therapy after full-dose IV rt-PA in patients with persisting occlusion and/or lack of clinical improvement appears safe compared with IV rt-PA alone or low-dose IV rt-PA followed by IAT. A high rate of recanalization and favorable outcome can be achieved.

AB - BACKGROUND AND PURPOSE - The optimal approach for acute ischemic stroke patients who do not respond to intravenous recombinant tissue plasminogen activator (IV rt-PA) is uncertain. This study evaluated the safety and response to intra-arterial thrombolytics (IATs) in patients unresponsive to full-dose IV rt-PA. METHODS - A case series from a prospectively collected database on consecutive acute ischemic stroke patients treated with IATs after 0.9 mg/kg IV rt-PA during a 7-year interval was collected. Primary outcome measures included symptomatic intracranial hemorrhage and mortality. As indicators of response, secondary outcome measures were recanalization and discharge disposition. RESULTS - Sixty-nine patients (mean±SD age, 60±13 years; range, 26 to 85 years; 55% male) with a median pretreatment National Institutes of Health Stroke Scale score of 18 (range, 6 to 39) were included. IV rt-PA was started at 124±32 minutes (median, 120 minutes) and IAT, at 288±57 minutes (median, 285 minutes). IATs consisted of reteplase (n=56), alteplase (n=7), and urokinase (n=6), with an average total dosage of 2.8 U, 8.6 mg, and 700 000 U, respectively. Symptomatic intracranial hemorrhage occurred in 4 of 69 (5.8%) patients; 3 cases were fatal. Recanalization was achieved in 50 (72.5%) and a favorable outcome (home or inpatient rehabilitation) in 38 (55%). CONCLUSIONS - IAT therapy after full-dose IV rt-PA in patients with persisting occlusion and/or lack of clinical improvement appears safe compared with IV rt-PA alone or low-dose IV rt-PA followed by IAT. A high rate of recanalization and favorable outcome can be achieved.

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