Safety and efficacy of intravenous tissue plasminogen activator and heparin in acute middle cerebral artery stroke.

Abstract

Background and Purpose:There is little reported of the safety and efficacy of high-dose intravenous recombinant tissue plasminogen activator (alteplase) in combination with heparin anticoagulation in patients presenting with acute ischemic stroke.Methods: Thirty-two patients with severe hemispheric stroke syndrome caused by angiographically proven middle cerebral artery and/or intracranial internal carotid artery occlusion were treated with 100 mg alteplase by intravenous infusion over 90 minutes within a mean±SD of 226±68 minutes after symptom onset Recanalization was assessed by digital subtraction angiography in all patients immediately after treatment and by transcranial Doppler monitoring (/i=30) and/or a third angiogram (n=5) 12-24 hours later.Results: Complete or partial reperfusion was observed in 11 patients (34%) 90 minutes after the initiation of alteplase infusion and in 17 patients (53%) within 12-24 hours. Hemorrhagic infarction without clinical deterioration was detected by follow-up computed tomography in nine patients (28%). Fatal parenchymal hemorrhage occurred in three patients (9%) with huge middle cerebral artery infarcts. Serious hemorrhage from the puncture site occurred in two patients (6%). Good clinical outcome correlated with reperfusion (p<0.05) and the presence of grade 2 collateral blood flow (p<0.01).Conclusions: When 100 mg of recombinant tissue plasminogen activator was given within the first 6 hours of acute stroke together with heparin the incidence of deleterious hemorrhage was <10%. Reperfusion and effective collateral blood flow seem to be two important factors associated with a small infarct volume and good clinical outcome. (Stroke 1992^3:646-652) KEY WORDS • cerebral ischemia • collateral circulation • plasminogen activator, tissue-type

Early Recanalization After Intravenous Administration of Recombinant Tissue Plasminogen Activator as Assessed by Pre- and Post-Thrombolytic Angiography in Acute Ischemic Stroke Patients

“…7 A study using 100 mg of rt-PA demonstrated recanalization rates of 9% in the ICA, 38.8% in the proximal MCA, and 100% in the distal MCA occlusion. 8 Our data are consistent with those studies in that it shows very low recanalization rates in the ICA and proximal MCA occlusions.…”

Systematic Review of Methods for Assessing Leptomeningeal Collateral Flow

“…4, Reliability assessments were available for 2 of these methods, demonstrating good and very good inter-/intraobserver agreement (n ϭ 172). 6,14,40 Arterial injection sites, when described, included unilateral carotid/MCA (n ϭ 3), 34,54,56 bilateral carotid (n ϭ 3), 24,52,63 a minimum of ipsilateral carotid and vertebral (n ϭ 10), 9,31,36,38,39,45,51,53,55,58 and other combinations (n ϭ 5). 10,11,28,49,50 Seven grading scales by using CTA were identified, with LMF assessments performed on 593 patients with suspected acute stroke (Table 3).…”

Intravenous Thrombolytics for Ischemic Stroke

“…Furthermore, results of these 2 phase I studies led to the eventual 0.9 mg/kg alteplase dose that is currently being used. Other studies that took place at approximately the same time generated similar results [3,41]. Authors del Zoppo et al [42] contributed important IV t-PA doserate escalation information in 139 patients who had recanalization monitored by a conventional angiogram.…”