Abstract
We sought to compare the safety and efficacy of combined intravenous (IV) and intra-arterial (IA) thrombolysis with primary IA therapy using tissue plasminogen activator for acute ischemic stroke presenting within 6 hours of symptom onset. We performed quasirandomization of a single institution's prospectively collected stroke database, comparing IV/IA (0.6 mg/kg IV < or = 60 mg, followed by 0.3 mg/kg IA < or = 30 mg) versus primary IA. Outcome measures include 90-day modified Rankin scale score, mortality, symptomatic intracerebral hemorrhage, and recanalization rates. Statistical analysis was performed using bivariate and propensity score methods. Of 1057 patients, 41 patients were treated with IV/IA, and 55 with IA. There was significant difference in time to treatment (mean of 151 minutes for the combined group and 261 minutes for the IA, P < .0001) and arterial tissue plasminogen activator dose (17.5 mg for IV/IA v 22.8 mg for IA only, P = .05). Propensity score matching yielded 25 patients in each group. Symptomatic intracerebral hemorrhage rate was 12% in each group. Mortality was 20% in the IV/IA group versus 16% in the IA group (relative risk 1.3 [0.4-4.1], P = .7). More patients in IV/IA group had modified Rankin scal...Continue Reading
References
May 11, 1992·Stroke; a Journal of Cerebral Circulation·T G BrottR Reed
Dec 14, 1995·The New England Journal of Medicine·UNKNOWN National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group
Nov 22, 1997·Stroke; a Journal of Cerebral Circulation
Nov 22, 1997·Stroke; a Journal of Cerebral Circulation
Feb 12, 1998·Annals of Internal Medicine·D B Rubin
Jan 28, 1998·Stroke; a Journal of Cerebral Circulation·G J del ZoppoM Gent
Nov 5, 1998·Statistics in Medicine·R B D'Agostino
Aug 3, 1999·Radiology·J L SunshineJ S Lewin
Oct 8, 1999·Stroke; a Journal of Cerebral Circulation·J I SuarezD M Landis
Dec 3, 1999·Stroke; a Journal of Cerebral Circulation·C A LewandowskiT Brott
Dec 11, 1999·JAMA : the Journal of the American Medical Association·A FurlanF Rivera
Mar 17, 2000·Current Opinion in Neurology·D C Tong, G W Albers
Nov 4, 2000·Stroke; a Journal of Cerebral Circulation·R ErnstJ Broderick
Dec 13, 2000·Neurology·J R MarlerT P Kwiatkowski
Feb 15, 2002·Neurosurgery·Jose I SuarezDennis M D Landis
Mar 16, 2004·Stroke; a Journal of Cerebral Circulation·UNKNOWN IMS Study Investigators
May 26, 2007·Stroke; a Journal of Cerebral Circulation·UNKNOWN IMS II Trial Investigators
Citations
Jun 19, 2012·Journal of Neurointerventional Surgery·Raul G NogueiraLee H Schwamm
May 30, 2009·Vascular Health and Risk Management·Giuseppe MicieliPiera Angela Tosi
Sep 3, 2014·Trials·Puck S S FransenUNKNOWN MR CLEAN Investigators
Sep 21, 2013·Journal of Neurointerventional Surgery·Kaiz S AsifOsama Zaidat
Jan 10, 2009·AJNR. American Journal of Neuroradiology·H J CloftD F Kallmes
Apr 24, 2009·AJNR. American Journal of Neuroradiology·R G NogueiraJ A Hirsch
Apr 1, 2011·Expert Opinion on Drug Discovery·Monika KillerErasmia Broussalis
Feb 8, 2011·Expert Opinion on Pharmacotherapy·Radoslav Raychev, Bruce Ovbiagele
Sep 15, 2012·Emergency Medicine Clinics of North America·Jasmeet Singh, Thanh Ngoc Nguyen
Dec 3, 2011·Drug Discovery Today·Erasmia BroussalisJörg Kraus
Jan 26, 2010·Journal of Pharmacological and Toxicological Methods·Ellen L Hughes, Felicity N E Gavins
Nov 17, 2009·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Alexandros L GeorgiadisAdnan I Qureshi
Oct 9, 2009·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Jefferson T MileyAdnan I Qureshi
Sep 28, 2012·International Journal of Stroke : Official Journal of the International Stroke Society·Rohit BhatiaMichael D Hill
Jul 19, 2014·European Journal of Internal Medicine·Jonathan BirnsAjay Bhalla
Oct 23, 2010·Vascular Medicine·Rajan Ag Patel, Christopher J White
Oct 12, 2010·The Cochrane Database of Systematic Reviews·Killian O'RourkePeter J Kelly
Apr 25, 2012·Stroke; a Journal of Cerebral Circulation·Mikael MazighiPierre Amarenco
Jul 18, 2009·Journal of Korean Neurosurgical Society·Seung Young JeongHa Young Choi
Apr 7, 2010·Nature Reviews. Neurology·Ruo-Li ChenAlastair M Buchan
May 12, 2018·Stroke; a Journal of Cerebral Circulation·Marc FerrignoHilde Henon
Apr 3, 2019·Acta neurologica Belgica·Gokhan Ozdemir
Sep 30, 2017·Stroke and Vascular Neurology·Yi DongQiang Dong
Oct 7, 2020·Applied Neuropsychology. Adult·Michele TorrisiFrancesca Antonia Arcadi
Jun 15, 2021·The Cochrane Database of Systematic Reviews·Melinda B RoaldsenHaakon Lindekleiv