Utility of a rescue endovascular therapy for the treatment of major strokes refractory to full-dose intravenous thrombolysis

Abstract

of a rescue endovascular therapy for the treatment of major strokes refractory to full-dose intravenous thrombolysis. Br J Radiol 2014;87:20130545. FULL PAPER Utility of a rescue endovascular therapy for the treatment of major strokes refractory to full-dose intravenous thrombolysis Objective: Large artery occlusion (LAO) in patients with major stroke predicts poor revascularization by intravenous thrombolysis (IVT) and more likely results in a poor outcome. We focused on the effects of intraarterial thrombolysis (IAT) and endovascular mechanical recanalization (EMR) as rescue therapies in major strokes refractory to IVT. Methods: A retrospective analysis of 87 patients (National Institutes of Health Stroke Scale .20), who did not respond to full-dose IVT due to LAO, was performed based on their endovascular therapy status. IAT was performed as an intraclot infusion of alteplase, and EMR was provided by the Solitaire device™ (Covidien, Dubin, Ireland). The recanalization and 3-month outcome rates after IAT/EMR were correlated with a group of patients who were scheduled to receive endovascular treatment but who underwent only IVT.Results: We achieved successful recanalization by IAT and EMR in 68.7% and 76.1% of patients, respectively. Despite no significant differences in mortality between IAT and EMR, a trend towards better outcomes after IAT and a statistically significant increase for outcomemodified Rankin scale (mRS) 0-3 (45.7%) and mRS 0-2 (34.9%) after EMR was noted when compared with IVT.