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Is intra-arterial thrombolysis safe after full-dose intravenous recombinant tissue plasminogen activator for acute ischemic stroke?
| Content Provider | Semantic Scholar |
|---|---|
| Author | Shaltoni, Hashem Khaja, Aslam M. Sugg, Rebecca M. Campbell, Morgan S. Noser, Elizabeth Anne |
| Copyright Year | 2007 |
| 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. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://stroke.ahajournals.org/content/strokeaha/38/1/80.full.pdf?download=true |
| Alternate Webpage(s) | http://stroke.ahajournals.org/content/strokeaha/38/1/80.full.pdf |
| PubMed reference number | 17122433v1 |
| Volume Number | 38 |
| Issue Number | 1 |
| Journal | Stroke |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Cerebral Infarction Cerebrovascular accident Fibrinolytic Agents Hemorrhage Intracranial Hemorrhages Patients Recombinants Reteplase Sixty Nine Thrombolysis, function Urokinase alteplase |
| Content Type | Text |
| Resource Type | Article |
