Background
Intra-arterial alteplase (IA tPA) is commonly used during mechanical thrombectomy
for acute ischemic stroke in patients with large-vessel occlusion, but specific indications
and applications for its use remain undefined.
Methods
We analyzed 40 patients who underwent stent-retriever mechanical thrombectomy, 28
of whom received adjunctive IA tPA. To our knowledge, this is the largest cohort with
this concomitant treatment reported in the literature in the post-mechanical thrombectomy
trial era.
Results
Between patients with and without IA tPA, rates of hemorrhagic conversion, neurologic
outcome, and mortality were equivalent, with a trend toward improved angiographic
revascularization observed in the IA tPA group.
Conclusions
IA tPA is a safe adjunct to mechanical thrombectomy, and more investigation is warranted
to understand ideal indications and dosage methodologies.
Key Words
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Article info
Publication history
Published online: August 23, 2017
Accepted:
July 27,
2017
Received in revised form:
July 13,
2017
Received:
May 9,
2017
Footnotes
Work was performed in the Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL.
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author contributions: DMH: study design, data analysis, manuscript preparation. DDL: data collection, manuscript preparation. NCP: data collection, manuscript preparation. AMS: data collection, manuscript preparation. AT: procedure performance, manuscript preparation. WWA: procedure performance, study design, data compilation, data analysis, manuscript preparation.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.07.031
Copyright
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
