Intra-arterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients in the United States: A case control analysis

Kwok, Chun Shing; Bains, Navpreet; Ford, Daniel E.; Gomez, Camilo R.; Hanley, Daniel F.; Hassan, Ameer E; Nguyen, Thanh N.; Siddiq, Farhan; Spiotta, Alejandro M; Zaidi, Syed; Qureshi, Adnan I

doi:10.1016/j.jstrokecerebrovasdis.2023.107093

Cited by 2 publications

(2 citation statements)

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“…When EVT fails to establish adequate perfusion, intra-arterial thrombolysis can be considered. [52][53][54][55][56] The safety and efficacy of intra-arterial urokinase after failed, unsuccessful, or incomplete mechanical thrombectomy in anterior circulation largevessel occlusion stroke was studied in an observational study conducted between 2010 and 2017. 57 The urokinase group consisted of patients who failed reperfusion, had a longer time from groin puncture to reperfusion (median: 72 vs. 43 minutes in the group without intra-arterial urokinase), and had worse Abbreviations: EVT, endovascular thrombectomy; mRS, modified Rankin scale, scores on the mRS for the assessment of global disability range from 0 (no symptoms) to 6 (death); mTICI, modified thrombolysis in cerebral infarction scale, ranges from 0 to 3, with a grade of 2b indicating reperfusion of more than 50% of the affected territory and 3 indicating complete reperfusion.…”

Section: Intra-arterial Thrombolytics In Endovascular Therapymentioning

confidence: 99%

“…When EVT fails to establish adequate perfusion, intra-arterial thrombolysis can be considered. 52 53 54 55 56 The safety and efficacy of intra-arterial urokinase after failed, unsuccessful, or incomplete mechanical thrombectomy in anterior circulation large-vessel occlusion stroke was studied in an observational study conducted between 2010 and 2017. 57 The urokinase group consisted of patients who failed reperfusion, had a longer time from groin puncture to reperfusion (median: 72 vs. 43 minutes in the group without intra-arterial urokinase), and had worse mTICI grades (30% had TICI-2a and lower vs. 19.7% in the control group).…”

Section: Intra-arterial Thrombolytics In Endovascular Therapymentioning

confidence: 99%

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Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Starikova,

Räty,

Strbian

et al. 2023

Semin Neurol

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The last decade's progress in demonstrating the clinical benefit of endovascular thrombectomy (EVT) in patients with large vessel occlusion stroke has transformed the paradigm of care for these patients. This review presents the milestones in implementing EVT as standard of care, demonstrates the current state of evidence, provides guidance for identifying the candidate patient for EVT, and highlights unsolved and controversial issues. Ongoing trials investigate broadening of EVT indications for patients who present with large core infarction, adjunctive intra-arterial thrombolysis, medium vessel occlusion, low NIHSS, and tandem occlusion.

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Section: Intra-arterial Thrombolytics In Endovascular Therapymentioning

confidence: 99%

Section: Intra-arterial Thrombolytics In Endovascular Therapymentioning

confidence: 99%

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Starikova,

Räty,

Strbian

et al. 2023

Semin Neurol

Self Cite

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Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis

Elawady,

Abo Kasem,

Mulpur

et al. 2024

J NeuroIntervent Surg

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BackgroundA combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.MethodsSTAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0–2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality.ResultsA total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51–1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0–1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0–1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04).ConclusionThe combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.

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Intra-arterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients in the United States: A case control analysis

Cited by 2 publications

References 20 publications

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis

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