TY - JOUR
T1 - Intra-Arterial Tissue Plasminogen Activator Is a Safe Rescue Therapy with Mechanical Thrombectomy
AU - Anadani, Mohammad
AU - Ajinkya, Shaun
AU - Alawieh, Ali
AU - Vargas, Jan
AU - Chatterjee, Arindam
AU - Turk, Aquilla
AU - Spiotta, Alejandro M.
N1 - Funding Information:
Conflict of interest statement: Dr. Spiotta: consulting—Penumbra, Minnetronix, Cerenovus. Dr. Turk: consulting—Codman, Penumbra, Microvention, Blockade, Pulsar Vascular, Medtronic, Siemens Research; grants—Codman, Penumbra, Microvention, Pulsar Vascular, Medtronic; and stock—Pulsar Vascular, Blockade. The remaining authors report no disclosure.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/3
Y1 - 2019/3
N2 - 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.
AB - 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.
KW - Hemorrhage
KW - Stroke
KW - Thrombectomy
KW - Tissue plasminogen activator
UR - http://www.scopus.com/inward/record.url?scp=85059528222&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2018.11.232
DO - 10.1016/j.wneu.2018.11.232
M3 - Article
C2 - 30529522
AN - SCOPUS:85059528222
VL - 123
SP - e604-e608
JO - World Neurosurgery
JF - World Neurosurgery
SN - 1878-8750
ER -