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<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="Therapeutic Results of Intra-Arterial Thrombolysis after Full-Dose Intravenous Tissue Plasminogen Activator Administration" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2084" />
<meta name="DC.Date" content="2010-09-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: IV administration of tPA is accepted as a standard treatment for acute cerebral ischemia, but the clinical outcomes cannot be guaranteed in patients who are not recanalized after IV-tPA and in those who are not eligible for IV-tPA. In this study, outcomes from groups of patients treated with additional IA thrombolytic therapy with the use or omission of IV-tPA administration were compared.

MATERIALS AND METHODS: IA thrombolytic therapy (thrombolytic agents combined with mechanical intervention) was attempted in those patients who were not eligible for IV-tPA and who showed continuous major vessel occlusion after IV-tPA. Sixty-three patients were divided into 2 groups: a tPA group ( n = 29, IA thrombolysis after IV-tPA) and a non-tPA group ( n = 34, IA thrombolysis without IV-tPA). These groups were subdivided according to match or mismatch DWI/PWI after MR imaging. Treatment results were compared by recanalization rate, clinical outcome, mortality, and ICH rate.

RESULTS: The recanalization rate was 79.3% in the tPA group and 55.9% in the non-tPA group (χ2 test, P &lt; .05). Subgroup analysis between DWI/PWI mismatch in the tPA group and DWI/PWI mismatch in the non-tPA group also showed no statistical difference in recanalization rate, favorable clinical outcome, and mortality (χ2 test, P &gt; .05), but the significant ICH rate was high in the tPA group (χ2 test, P &lt; .05).

CONCLUSIONS: Additional IA thrombolytic treatment after full-dose IV-tPA administration might be an acceptable treatment option for patients with DWI/PWI mismatch.

Angio
:   angiography
D/P
:   diffusion/perfusion
DWI
:   diffusion-weighted imaging
EVD
:   extra-ventricular drainage
GCS
:   Glasgow Coma Scale
GP IIb/IIa
:   platelet glycoprotein receptor IIb/IIa
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IICP
:   increased intracranial pressure
IV
:   intravenous
Lt.
:   left
MCA
:   middle cerebral artery
MRI
:   MR imaging
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
NINDS
:   National Institute of Neurological Disorders and Stroke
PWI
:   perfusion-weighted imaging
Rt.
:   right
Sx.
:   symptom
TIMI
:   Thrombolysis in Myocardial Infarction
tPA
:   tissue plasminogen activator
Tx.
:   treatment" />
<meta name="DC.Contributor" content="D.-S. Yoo" />
<meta name="DC.Contributor" content="Y.-D. Won" />
<meta name="DC.Contributor" content="P.-W. Huh" />
<meta name="DC.Contributor" content="H.-E. Shin" />
<meta name="DC.Contributor" content="K.-T. Kim" />
<meta name="DC.Contributor" content="S.-G. Kang" />
<meta name="DC.Contributor" content="S.-B. Lee" />
<meta name="DC.Contributor" content="K.-S. Cho" />
<meta name="article:published_time" content="2010-09-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Therapeutic Results of Intra-Arterial Thrombolysis after Full-Dose Intravenous Tissue Plasminogen Activator Administration" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;IV administration of tPA is accepted as a standard treatment for acute cerebral ischemia, but the clinical outcomes cannot be guaranteed in patients who are not recanalized after IV-tPA and in those who are not eligible for IV-tPA. In this study, outcomes from groups of patients treated with additional IA thrombolytic therapy with the use or omission of IV-tPA administration were compared.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;IA thrombolytic therapy (thrombolytic agents combined with mechanical intervention) was attempted in those patients who were not eligible for IV-tPA and who showed continuous major vessel occlusion after IV-tPA. Sixty-three patients were divided into 2 groups: a tPA group (&lt;i&gt;n&lt;/i&gt; = 29, IA thrombolysis after IV-tPA) and a non-tPA group (&lt;i&gt;n&lt;/i&gt; = 34, IA thrombolysis without IV-tPA). These groups were subdivided according to match or mismatch DWI/PWI after MR imaging. Treatment results were compared by recanalization rate, clinical outcome, mortality, and ICH rate.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The recanalization rate was 79.3% in the tPA group and 55.9% in the non-tPA group (χ&lt;sup&gt;2&lt;/sup&gt; test, &lt;i&gt;P&lt;/i&gt; &amp;lt; .05). Subgroup analysis between DWI/PWI mismatch in the tPA group and DWI/PWI mismatch in the non-tPA group also showed no statistical difference in recanalization rate, favorable clinical outcome, and mortality (χ&lt;sup&gt;2&lt;/sup&gt; test, &lt;i&gt;P&lt;/i&gt; &amp;gt; .05), but the significant ICH rate was high in the tPA group (χ&lt;sup&gt;2&lt;/sup&gt; test, &lt;i&gt;P&lt;/i&gt; &amp;lt; .05).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Additional IA thrombolytic treatment after full-dose IV-tPA administration might be an acceptable treatment option for patients with DWI/PWI mismatch.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="twitter:title" content="Therapeutic Results of Intra-Arterial Thrombolysis after Full-Dose Intravenous Tissue Plasminogen Activator Administration" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: IV administration of tPA is accepted as a standard treatment for acute cerebral ischemia, but the clinical outcomes cannot be guaranteed in patients who are not recanalized after IV-tPA and in those who are not eligible for IV-tPA. In this study, outcomes from groups of patients treated with additional IA thrombolytic therapy with the use or omission of IV-tPA administration were compared.

MATERIALS AND METHODS: IA thrombolytic therapy (thrombolytic agents combined with mechanical intervention) was attempted in those patients who were not eligible for IV-tPA and who showed continuous major vessel occlusion after IV-tPA. Sixty-three patients were divided into 2 groups: a tPA group ( n = 29, IA thrombolysis after IV-tPA) and a non-tPA group ( n = 34, IA thrombolysis without IV-tPA). These groups were subdivided according to match or mismatch DWI/PWI after MR imaging. Treatment results were compared by recanalization rate, clinical outcome, mortality, and ICH rate.

RESULTS: The recanalization rate was 79.3% in the tPA group and 55.9% in the non-tPA group (χ2 test, P &lt; .05). Subgroup analysis between DWI/PWI mismatch in the tPA group and DWI/PWI mismatch in the non-tPA group also showed no statistical difference in recanalization rate, favorable clinical outcome, and mortality (χ2 test, P &gt; .05), but the significant ICH rate was high in the tPA group (χ2 test, P &lt; .05).

CONCLUSIONS: Additional IA thrombolytic treatment after full-dose IV-tPA administration might be an acceptable treatment option for patients with DWI/PWI mismatch.

Angio
:   angiography
D/P
:   diffusion/perfusion
DWI
:   diffusion-weighted imaging
EVD
:   extra-ventricular drainage
GCS
:   Glasgow Coma Scale
GP IIb/IIa
:   platelet glycoprotein receptor IIb/IIa
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IICP
:   increased intracranial pressure
IV
:   intravenous
Lt.
:   left
MCA
:   middle cerebral artery
MRI
:   MR imaging
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
NINDS
:   National Institute of Neurological Disorders and Stroke
PWI
:   perfusion-weighted imaging
Rt.
:   right
Sx.
:   symptom
TIMI
:   Thrombolysis in Myocardial Infarction
tPA
:   tissue plasminogen activator
Tx.
:   treatment" />
<meta name="og-title" property="og:title" content="Therapeutic Results of Intra-Arterial Thrombolysis after Full-Dose Intravenous Tissue Plasminogen Activator Administration" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/8/1536" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: IV administration of tPA is accepted as a standard treatment for acute cerebral ischemia, but the clinical outcomes cannot be guaranteed in patients who are not recanalized after IV-tPA and in those who are not eligible for IV-tPA. In this study, outcomes from groups of patients treated with additional IA thrombolytic therapy with the use or omission of IV-tPA administration were compared.

MATERIALS AND METHODS: IA thrombolytic therapy (thrombolytic agents combined with mechanical intervention) was attempted in those patients who were not eligible for IV-tPA and who showed continuous major vessel occlusion after IV-tPA. Sixty-three patients were divided into 2 groups: a tPA group ( n = 29, IA thrombolysis after IV-tPA) and a non-tPA group ( n = 34, IA thrombolysis without IV-tPA). These groups were subdivided according to match or mismatch DWI/PWI after MR imaging. Treatment results were compared by recanalization rate, clinical outcome, mortality, and ICH rate.

RESULTS: The recanalization rate was 79.3% in the tPA group and 55.9% in the non-tPA group (χ2 test, P &lt; .05). Subgroup analysis between DWI/PWI mismatch in the tPA group and DWI/PWI mismatch in the non-tPA group also showed no statistical difference in recanalization rate, favorable clinical outcome, and mortality (χ2 test, P &gt; .05), but the significant ICH rate was high in the tPA group (χ2 test, P &lt; .05).

CONCLUSIONS: Additional IA thrombolytic treatment after full-dose IV-tPA administration might be an acceptable treatment option for patients with DWI/PWI mismatch.

Angio
:   angiography
D/P
:   diffusion/perfusion
DWI
:   diffusion-weighted imaging
EVD
:   extra-ventricular drainage
GCS
:   Glasgow Coma Scale
GP IIb/IIa
:   platelet glycoprotein receptor IIb/IIa
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IICP
:   increased intracranial pressure
IV
:   intravenous
Lt.
:   left
MCA
:   middle cerebral artery
MRI
:   MR imaging
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
NINDS
:   National Institute of Neurological Disorders and Stroke
PWI
:   perfusion-weighted imaging
Rt.
:   right
Sx.
:   symptom
TIMI
:   Thrombolysis in Myocardial Infarction
tPA
:   tissue plasminogen activator
Tx.
:   treatment" />
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      <h1 class="highwire-cite-title" id="page-title">Therapeutic Results of Intra-Arterial Thrombolysis after Full-Dose Intravenous Tissue Plasminogen Activator Administration</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">D.-S. Yoo</span>, <span class="highwire-citation-author" data-delta="1">Y.-D. Won</span>, <span class="highwire-citation-author" data-delta="2">P.-W. Huh</span>, <span class="highwire-citation-author" data-delta="3">H.-E. Shin</span>, <span class="highwire-citation-author" data-delta="4">K.-T. Kim</span>, <span class="highwire-citation-author" data-delta="5">S.-G. Kang</span>, <span class="highwire-citation-author" data-delta="6">S.-B. Lee</span> and <span class="highwire-citation-author" data-delta="7">K.-S. Cho</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1536-1540; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2084 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9804--6918960979" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">D.-S. Yoo </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.-S.%2BYoo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yoo%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.-S.%2BYoo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Y.-D. 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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> IV administration of tPA is accepted as a standard treatment for acute cerebral ischemia, but the clinical outcomes cannot be guaranteed in patients who are not recanalized after IV-tPA and in those who are not eligible for IV-tPA. In this study, outcomes from groups of patients treated with additional IA thrombolytic therapy with the use or omission of IV-tPA administration were compared.</p>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> IA thrombolytic therapy (thrombolytic agents combined with mechanical intervention) was attempted in those patients who were not eligible for IV-tPA and who showed continuous major vessel occlusion after IV-tPA. Sixty-three patients were divided into 2 groups: a tPA group (<em>n</em> = 29, IA thrombolysis after IV-tPA) and a non-tPA group (<em>n</em> = 34, IA thrombolysis without IV-tPA). These groups were subdivided according to match or mismatch DWI/PWI after MR imaging. Treatment results were compared by recanalization rate, clinical outcome, mortality, and ICH rate.</p>
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<p id="p-3"><strong>RESULTS:</strong> The recanalization rate was 79.3% in the tPA group and 55.9% in the non-tPA group (χ<sup>2</sup> test, <em>P</em> &lt; .05). Subgroup analysis between DWI/PWI mismatch in the tPA group and DWI/PWI mismatch in the non-tPA group also showed no statistical difference in recanalization rate, favorable clinical outcome, and mortality (χ<sup>2</sup> test, <em>P</em> &gt; .05), but the significant ICH rate was high in the tPA group (χ<sup>2</sup> test, <em>P</em> &lt; .05).</p>
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<p id="p-4"><strong>CONCLUSIONS:</strong> Additional IA thrombolytic treatment after full-dose IV-tPA administration might be an acceptable treatment option for patients with DWI/PWI mismatch.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">Angio<span class="def-item-dt-sep"></span></dt><dd>angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">D/P<span class="def-item-dt-sep"></span></dt><dd>diffusion/perfusion<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">DWI<span class="def-item-dt-sep"></span></dt><dd>diffusion-weighted imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">EVD<span class="def-item-dt-sep"></span></dt><dd>extra-ventricular drainage<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">GCS<span class="def-item-dt-sep"></span></dt><dd>Glasgow Coma Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">GP IIb/IIa<span class="def-item-dt-sep"></span></dt><dd>platelet glycoprotein receptor IIb/IIa<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">IA<span class="def-item-dt-sep"></span></dt><dd>intra-arterial<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">ICH<span class="def-item-dt-sep"></span></dt><dd>intracerebral hemorrhage<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">IICP<span class="def-item-dt-sep"></span></dt><dd>increased intracranial pressure<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">IV<span class="def-item-dt-sep"></span></dt><dd>intravenous<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">Lt.<span class="def-item-dt-sep"></span></dt><dd>left<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">MCA<span class="def-item-dt-sep"></span></dt><dd>middle cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">MRI<span class="def-item-dt-sep"></span></dt><dd>MR imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">mRS<span class="def-item-dt-sep"></span></dt><dd>modified Rankin Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">NIHSS<span class="def-item-dt-sep"></span></dt><dd>National Institutes of Health Stroke Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-17">NINDS<span class="def-item-dt-sep"></span></dt><dd>National Institute of Neurological Disorders and Stroke<span class="def-item-dd-sep"></span></dd><dt id="def-item-18">PWI<span class="def-item-dt-sep"></span></dt><dd>perfusion-weighted imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-19">Rt.<span class="def-item-dt-sep"></span></dt><dd>right<span class="def-item-dd-sep"></span></dd><dt id="def-item-20">Sx.<span class="def-item-dt-sep"></span></dt><dd>symptom<span class="def-item-dd-sep"></span></dd><dt id="def-item-21">TIMI<span class="def-item-dt-sep"></span></dt><dd>Thrombolysis in Myocardial Infarction<span class="def-item-dd-sep"></span></dd><dt id="def-item-22">tPA<span class="def-item-dt-sep"></span></dt><dd>tissue plasminogen activator<span class="def-item-dd-sep"></span></dd><dt id="def-item-23">Tx.<span class="def-item-dt-sep"></span></dt><dd>treatment</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/8/1536.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 2010 </div></div>
      
      
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      <div class="highwire-cite-title">Therapeutic Results of Intra-Arterial Thrombolysis after Full-Dose Intravenous Tissue Plasminogen Activator Administration</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1536-1540; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2084 </span></div>
  
  
  
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      <div class="highwire-cite-title">Therapeutic Results of Intra-Arterial Thrombolysis after Full-Dose Intravenous Tissue Plasminogen Activator Administration</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">D.-S.</span> <span class="nlm-surname">Yoo</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Y.-D.</span> <span class="nlm-surname">Won</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">P.-W.</span> <span class="nlm-surname">Huh</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">H.-E.</span> <span class="nlm-surname">Shin</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.-T.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S.-G.</span> <span class="nlm-surname">Kang</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.-B.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">K.-S.</span> <span class="nlm-surname">Cho</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1536-1540; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2084 </span></div>
  
  
  
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