Intra-Arterial Tissue Plasminogen Activator Is a Safe Rescue Therapy with Mechanical Thrombectomy

Introduction: Intra-arterial tissue plasminogen activator (IA-tPA) has been widely used in conjunction with mechanical thrombectomy (MT) or as rescue therapy. Data on the safety of IA-tPA as a rescue therapy are scarce. Objective: To report the safety outcome of IA-tPA during MT with respect to hemorrhage and functional outcome. Methods: We reviewed our prospectively maintained data and identified patients who received mechanical thrombectomy between November 1, 2014, and January 30, 2018. Collected variables included demographics, comorbidities, baseline National Institutes of Health Stroke Scale, procedural variables, and outcome variables, which were subjected to a matched and unmatched analysis. Hemorrhagic transformation was classified based on European Cooperative Acute Stroke Study criteria. Functional outcome was assessed based on modified Rankin Scale. Results: A total of 486 patients were treated with MT during the study period, of whom 67 patients received IA tPA as a rescue therapy. IA tPA was used at the discretion of neuroendovascular surgeon if complete recanalization (modified Treatment in Cerebral Ischemia ≥2c) was not achieved with ADAPT (A Direct Aspiration First Pass Technique) or for distal occlusion that could not be reached with thrombectomy catheters. Both groups did not differ in baseline characteristics, comorbidities, or admission National Institutes of Health Stroke Scale. There was no significant difference in good outcome (modified Rankin Scale ≤2), death, any hemorrhage, or parenchymal hemorrhage type 2 between groups in matched and unmatched analyses. Conclusions: IA-tPA administration during MT was not associated with increased risk of hemorrhage in selected patients with incomplete recanalization after thrombectomy.