Intra-arterial thrombolytic therapy for acute intracranial large artery occlusive disease in patients selected by magnetic resonance image

Chang, Ku‐Chou; Hsu, Shin-Wei; Liou, Chia‐Wei; Huang, Yu‐Ting; Lee, Lien-Huey; Lui, Chun‐Chung; Kuo, Yeh-Lin

doi:10.1016/j.jns.2010.06.026

Cited by 11 publications

(6 citation statements)

References 30 publications

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“…4 Before the procedure, multiparametric neuroimaging is being used to select those patients with salvageable persistent ischemic penumbra that will benefit from the interventional procedure. 5 However, definitive evidence about its value for triage is still lacking. Furthermore, once the procedure is initiated if recanalization is not promptly achieved, the interventionalist does not have any source of information to make the decision about whether to continue the efforts to recanalize or stop the process.…”

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confidence: 99%

Extending the Time Window for Endovascular Procedures According to Collateral Pial Circulation

Ribó

Flores

Rubiera

et al. 2011

Stroke

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Background and Purpose— Good collateral pial circulation (CPC) predicts a favorable outcome in patients undergoing intra-arterial procedures. We aimed to determine if CPC status may be used to decide about pursuing recanalization efforts. Methods— Pial collateral score (0–5) was determined on initial angiogram. We considered good CPC when pial collateral score <3, defined total time of ischemia (TTI) as onset-to-recanalization time, and clinical improvement >4-point decline in admission–discharge National Institutes of Health Stroke Scale. Results— We studied CPC in 61 patients (31 middle cerebral artery, 30 internal carotid artery). Good CPC patients (n=21 [34%]) had lower discharge National Institutes of Health Stroke Scale score (7 versus 21; P =0.02) and smaller infarcts (56 mL versus 238 mL; P <0.001). In poor CPC patients, a receiver operating characteristic curve defined a TTI cutoff point <300 minutes (sensitivity 67%, specificity 75%) that better predicted clinical improvement (TTI <300: 66.7% versus TTI >300: 25%; P =0.05). For good CPC patients, no temporal cutoff point could be defined. Although clinical improvement was similar for patients recanalizing within 300 minutes (poor CPC: 60% versus good CPC: 85.7%; P =0.35), the likelihood of clinical improvement was 3-fold higher after 300 minutes only in good CPC patients (23.1% versus 90.1%; P =0.01). Similarly, infarct volume was reduced 7-fold in good as compared with poor CPC patients only when TTI >300 minutes (TTI <300: poor CPC: 145 mL versus good CPC: 93 mL; P =0.56 and TTI >300: poor CPC: 217 mL versus good CPC: 33 mL; P <0.01). After adjusting for age and baseline National Institutes of Health Stroke Scale score, TTI <300 emerged as an independent predictor of clinical improvement in poor CPC patients (OR, 6.6; 95% CI, 1.01–44.3; P =0.05) but not in good CPC patients. In a logistic regression, good CPC independently predicted clinical improvement after adjusting for TTI, admission National Institutes of Health Stroke Scale score, and age (OR, 12.5; 95% CI, 1.6–74.8; P =0.016). Conclusions— Good CPC predicts better clinical response to intra-arterial treatment beyond 5 hours from onset. In patients with stroke receiving endovascular treatment, identification of good CPC may help physicians when considering pursuing recanalization efforts in late time windows.

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confidence: 99%

Extending the Time Window for Endovascular Procedures According to Collateral Pial Circulation

Ribó

Flores

Rubiera

et al. 2011

Stroke

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“…Currently, an extensive research is focused on surrogate markers of tissue viability during endovascular procedures . In our study, the BIS monitoring in endovascular procedures was unable to show information about the viability of the tissue per procedure.…”

Section: Discussionmentioning

confidence: 79%

Monitoring of Cortical Activity Postreperfusion. A Powerful Tool for Predicting Clinical Response Immediately After Recanalization

Flores

Ribó

Rubiera

et al. 2014

Journal of Neuroimaging

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“…In previous studies, the dosage of urokinase infusion of IAT in patients with large artery occlusive was 500,000, 600,000, 900,000, 1,000,000, or 1,250,000 IU [21][22][23]. If IAT was combined with other therapeutic strategies (e.g., mechanical thrombectomy, intravenous thrombolysis or tirofiban), the dosage could be reduced to 100,000-200,000 IU [24,25].…”

Section: Discussionmentioning

confidence: 99%

Intra-Arterial Thrombolysis Improves the Prognosis of Acute Ischemic Stroke Patients without Large Vessel Occlusion

Shang

Zhao

et al. 2018

Eur Neurol

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Background and Purpose: Intravenous thrombolysis is known as the only effective reperfusion therapy for acute ischemic stroke (AIS) caused by small branches occlusion. However, it is still unclear whether intra-arterial thrombolysis (IAT) is safe and effective for patients without detectable arterial occlusion. This study evaluated the safety and efficacy of IAT in these patients. Methods: Data were collected on consecutive patients from December 2012 to February 2017 at the Xuanwu Hospital, Capital Medical University. AIS patients without large artery occlusion during digital subtraction angiography (DSA) were divided into 2 groups: (1) Intra-arterial urokinase thrombolysis group (UK group): received intra-arterial urokinase thrombolysis treatment; (2) Control group: cerebral angiography examination only. The primary outcome was 3-month favorable functional outcome (modified Rankin Scale 0–2). Results: A total of 48 patients received urokinase thrombolysis, and 34 patients underwent DSA examination only. The UK group had more frequent favorable functional outcomes (70.8 vs. 50%, p = 0.032) at 3-month follow-up and higher score of National Institutes of Health Stroke Scale improvement on the second day (p = 0.007). One patient (2%) had symptomatic intracerebral hemorrhage and 3 patients (6.3%) had asymptomatic intracerebral hemorrhage (asICH) in the UK group. One patient (3.3%) had asICH in the control group. There were no significant differences about ICH. Conclusions: AIS caused by small branches occlusion could benefit from intra-arterial urokinase thrombolysis, and the risk of intracerebral hemorrhage was not significantly higher.

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Intra-arterial thrombolytic therapy for acute intracranial large artery occlusive disease in patients selected by magnetic resonance image

Cited by 11 publications

References 30 publications

Extending the Time Window for Endovascular Procedures According to Collateral Pial Circulation

Extending the Time Window for Endovascular Procedures According to Collateral Pial Circulation

Monitoring of Cortical Activity Postreperfusion. A Powerful Tool for Predicting Clinical Response Immediately After Recanalization

Intra-Arterial Thrombolysis Improves the Prognosis of Acute Ischemic Stroke Patients without Large Vessel Occlusion

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