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Rescue localized intra-arterial thrombolysis for hyperacute MCA ischemic stroke patients after early non-responsive intravenous tissue plasminogen activator therapy

 Dong Joon Kim  ;  Dong Ik Kim  ;  Seo Hyun Kim  ;  Kyung Yeol Lee  ;  Ji Hoe Heo  ;  Sang Won Han 
 NEURORADIOLOGY, Vol.47(8) : 616-621, 2005 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Brain Ischemia/complications* ; Brain Ischemia/drug therapy* ; Drug Resistance ; Female ; Fibrinolytic Agents/administration & dosage* ; Fibrinolytic Agents/therapeutic use* ; Humans ; Infusions, Intra-Arterial ; Infusions, Intravenous ; Intracranial Hemorrhages ; Male ; Middle Aged ; Stroke/complications* ; Stroke/drug therapy* ; Thrombolytic Therapy/methods* ; Tissue Plasminogen Activator/administration & dosage* ; Tissue Plasminogen Activator/therapeutic use* ; Treatment Outcome
Therapy ; Thrombolytic ; Stroke ; Acute ; Cerebral ischemia
The outcome of patients who show no early response to intravenous (i.v.) tissue plasminogen activator (tPA) therapy is poor. The objective of this study was to evaluate the feasibility of rescue localized intra-arterial thrombolysis (LIT) therapy for acute ischemic stroke patients after an early non-responsive i.v. tPA therapy. Patients with proximal MCA occlusions who were treated by LIT (n=10) after failure of early response [no improvement or improvement of National Institute of Health Stroke Scale (NIHSS) scores of ≤3] to i.v. tPA therapy (0.9 mg/kg—10% bolus and 90% i.v. infusion over 60 min) were selected. The recanalization rates, incidence of post-thrombolysis hemorrhage and clinical outcomes [baseline and discharge NIHSS scores, mortality, 3 months Barthel index (BI) and modified Rankin score (mRS)] were evaluated. Rescue LIT therapy was performed on ten MCA occlusion patients (male:female=3:7, mean age 71 years). The mean time between the initiation of i.v. tPA therapy and the initiation of intra-arterial urokinase (i.a. UK) was 117±25.0 min [time to i.v. tPA 137±32 min; time to digital subtraction angiography (DSA) 221±42 min; time to i.a. UK 260±46 min]. The baseline NIHSS scores showed significant improvement at discharge (median from 18 to 6). Symptomatic hemorrhage and, consequent, mortality were noted in 2/10 (20%) patients. Three months good outcome was noted in 4/10 (40%, mRS 0–2) and 3/10 (30%, BI ≥95). In conclusion, rescue LIT therapy can be considered as a treatment option for patients not showing early response to full dose i.v. tPA therapy. Larger scale studies for further validation of this protocol may be necessary.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Han, Sang Won(한상원)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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