Systemic Thrombolysis in Patients With Acute Ischemic Stroke and Internal Carotid ARtery Occlusion

Abstract

Background and Purpose-The beneficial effect of intravenous thrombolytic therapy in patients with acute ischemic stroke attributable to internal carotid artery (ICA) occlusion remains unclear. The aim of this study was to evaluate the efficacy and safety of intravenous recombinant tissue-type plasminogen activator in these patients. Methods-ICARO was a case-control multicenter study on prospectively collected data. Patients with acute ischemic stroke and ICA occlusion treated with intravenous recombinant tissue-type plasminogen activator within 4.5 hours from symptom onset (cases) were compared to matched patients with acute stroke and ICA occlusion not treated with recombinant tissue-type plasminogen activator (controls). Cases and controls were matched for age, gender, and stroke

Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke

“…Among patients with occlusions of the intracranial internal carotid artery or the first segment of the middle cerebral artery (or both), intravenous t-PA results in early reperfusion in only 13 to 50%. [4][5][6][7] Neurovascular thrombectomy is a reperfusion strategy that is distinct from pharmacologic fibrinolysis. Endovascular mechanical treatments can remove large, proximal clots rapidly and result in higher rates of reperfusion than intravenous t-PA alone.…”

Segabrottnám við brátt blóðþurrðarslag er mesta framför í læknisfræði í áraraðir

“…7 Snemmbaert endurflaeði sést eingöngu hjá 13-20% sjúklinga með lokun á innankúpu innri hálsslagaeð eða fyrsta hluta miðheilaslagaaeðar eða báðum (mynd 1). [8][9][10][11] Auk þess virðist t-PA í bláaeð ekki eins gagnlegt við að opna lokanir staerri innankúpuslagaaeða sem valda um þriðjungi bráðra blóðþurrðarslaga í fremri blóðveitu. 12,13 Snemmbaer enduropnun eftir t-PA í bláaeð sést aðeins hjá þriðjungi sjúk-linga með lokanir á naeringarsvaeði innri hálsslagaeðar 14 en horfur án endurflaeðis eru vanalaga slaemar.…”

Pharmacological Treatment of Acute Ischemic Stroke: A Review

“…Also IV r-tPA has a major therapeutic limitation, including unresponsiveness of large thrombi to enzymatic digestion, resulting in a low Recanalization rate (13% to 15%) in Large Vessel Occlusion (LVO) stroke and a low rate of benefit in the patients having the most disabling stroke. To overcome these major limitations of IV r-tPA, endovascular approaches have been developed over the last two decades using catheters that are delivered intra-arterially (IA) to the site of the intracranial clot to recanalize the occluded vessel 19 .…”