Intraarterial Thrombolysis Trials in Acute Ischemic Stroke

Critical appraisal of medical devices in the management of cerebrovascular disease

“…However, this therapy can only be administered to those patients treated within three hours of acute symptom onset and the treatment is also limited to patients at low risk of systemic hemorrhagic complications such that patients on anticoagulants or who have undergone recent surgical procedures are ineligible for tPA. Furthermore, the benefit of intravenous tPA is thought to be less effective for patients with large strokes typically the result of large proximal cervico-cerebral arterial occlusions (Kasner 2004; Ng et al 2004). Intra-arterial mechanical and/or pharmacologic thrombolysis has been adopted as an alternate strategy for appropriate patients either as a substitute or in addition to intravenous TPA.…”

“…The argument has been that IV TPA does not open larger vessels such as the internal carotid artery or the proximal middle cerebral artery as well as more distal arterial occlusive lesions (ASITN et al 2001; Ng et al 2004). Furthermore, patients with large strokes (NIHSS > 20) have a much lower chance of improving to NIHSS 0 or 1.…”

Interventional neuroradiology

“…There are no randomised studies but many cases of thrombolysis are reported in the literature using local intra-arterial infusions of urokinase or rt-PA. 101 Successful recanalisation, either partial or complete, may be achieved in 70% (fig 11), over a median infusion time of 120 minutes resulting in survival rates of 55-70%. Survival rates in untreated or persistent occlusion is 0-10%.…”

“…Current opinion suggests that intra-arterial treatment may be useful for large vessel occlusions and in those Vertebrobasilar occlusion is usually associated with a poor prognosis with overall mortality rates of 70-80%. There are no randomised studies but many cases of thrombolysis are reported in the literature using local intra-arterial infusions of urokinase or rt-PA. 101 Successful recanalisation, either partial or complete, may be achieved in 70% (fig 11), over a median infusion time of 120 minutes resulting in survival rates of 55-70%. Survival rates in untreated or persistent occlusion is 0-10%.…”

Intra-Arterial Thrombolysis for Left Middle Cerebral Artery Embolic Stroke During Coronary Angiography

“…Recent studies comparing intra-arterial and intravenous thrombolytic therapy in thromboembolic stroke have shown a higher rate of revascularization with intra-arterial thrombolysis. 6,7 Previous trials have shown the safety and efficacy of intra-arterial thrombolysis with urokinase . 8,9 The reperfusion rate is Ϸ70% in atherosclerotic strokes within the first 6 hours and Ն75% within the first 3 hours.…”