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Sequential combination of intravenous recombinant tissue plasminogen activator and intra-arterial urokinase in acute ischemic stroke

 Kyung Yul Lee  ;  Dong Ik Kim  ;  Ji Hoe Heo  ;  Seung Min Kim  ;  Yong Woon Shim  ;  Hae Woong Chung  ;  Seung Ik Lee  ;  Seo Hyun Kim 
 AMERICAN JOURNAL OF NEURORADIOLOGY, Vol.25(9) : 1470-1475, 2004 
Journal Title
Issue Date
Abciximab ; Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal/administration & dosage ; Antibodies, Monoclonal/adverse effects ; Cerebral Angiography ; Cerebral Hemorrhage/chemically induced ; Cerebral Infarction/diagnostic imaging ; Cerebral Infarction/drug therapy* ; Drug Therapy, Combination ; Female ; Fibrinolytic Agents/administration & dosage* ; Fibrinolytic Agents/adverse effects ; Follow-Up Studies ; Humans ; Immunoglobulin Fab Fragments/administration & dosage ; Immunoglobulin Fab Fragments/adverse effects ; Injections, Intra-Arterial ; Injections, Intravenous ; Intracranial Embolism/diagnostic imaging ; Intracranial Embolism/drug therapy* ; Male ; Middle Aged ; Neurologic Examination/drug effects ; Recurrence ; Retreatment ; Thrombolytic Therapy/methods* ; Tissue Plasminogen Activator/administration & dosage* ; Tissue Plasminogen Activator/adverse effects ; Urokinase-Type Plasminogen Activator/administration & dosage* ; Urokinase-Type Plasminogen Activator/adverse effects
BACKGROUND AND PURPOSE: Combined intravenous (IV) and intra-arterial (IA) thrombolytic therapy may be faster and easier to initiate than monotherapy, and its recanalization rate may be better as well. The sequential combination of recombinant tissue plasminogen activator (rTPA) and urokinase (UK) has synergistic and complementary effects on clot lysis. We prospectively evaluated the effectiveness and safety of sequential combination of IV rTPA and IA UK in acute ischemic stroke. METHODS: IV rTPA was administered to patients with acute stroke within 3 hours of onset. Those whose condition had not improved at the end of rTPA infusion were further treated with selective IA UK. We evaluated baseline and 30-day National Institutes of Health Stroke Scale (NIHSS) scores and 90-day modified Rankin Scale scores. RESULTS: Thirty patients were initially treated with IV rTPA; 24 were further treated with IA UK. Four patients who had rapid reocclusion following initial successful IA therapy received IV abciximab. Fourteen of 24 patients who underwent angiography had an effective perfusion state of Thrombolysis in Myocardial Infarction grade 3 flow. Median baseline and 30-day NIHSS scores were 18 and 2, respectively. Eighteen patients improved to a modified Rankin scale score of 0 or 1 after 90 days. Symptomatic hemorrhage developed in two patients. CONCLUSION: The strategy of using conventional-dose IV rTPA and the sequential combination of IA UK in patients without an early clinical response to IV treatment was safe and feasible. This strategy achieved high complete arterial recanalization rates and good functional outcomes. Copyright American Society of Neuroradiology
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Seo Hyun(김서현)
Kim, Seung Min(김승민) ORCID logo https://orcid.org/0000-0002-4384-9640
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Lee, Seung Ik(이승익)
Chung, Hae Woong(정해웅)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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