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RT Journal Article
SR Electronic
T1 Therapeutic Results of Intra-Arterial Thrombolysis after Full-Dose Intravenous Tissue Plasminogen Activator Administration
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1536
OP 1540
DO 10.3174/ajnr.A2084
VO 31
IS 8
A1 Yoo, D.-S.
A1 Won, Y.-D.
A1 Huh, P.-W.
A1 Shin, H.-E.
A1 Kim, K.-T.
A1 Kang, S.-G.
A1 Lee, S.-B.
A1 Cho, K.-S.
YR 2010
UL http://www.ajnr.org/content/31/8/1536.abstract
AB 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. AngioangiographyD/Pdiffusion/perfusionDWIdiffusion-weighted imagingEVDextra-ventricular drainageGCSGlasgow Coma ScaleGP IIb/IIaplatelet glycoprotein receptor IIb/IIaIAintra-arterialICAinternal carotid arteryICHintracerebral hemorrhageIICPincreased intracranial pressureIVintravenousLt.leftMCAmiddle cerebral arteryMRIMR imagingmRSmodified Rankin ScaleNIHSSNational Institutes of Health Stroke ScaleNINDSNational Institute of Neurological Disorders and StrokePWIperfusion-weighted imagingRt.rightSx.symptomTIMIThrombolysis in Myocardial InfarctiontPAtissue plasminogen activatorTx.treatment