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  • Recanalization rate and clinical outcome of the large intracranial artery occluded patients, after intravenous tissue plasminogen infusion and additional intraarterial thrombolysis.

    Final Number:

    Dosung Yoo MD PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: The standard treatment modality in acute stroke patients is intravenous tissue plasminogen activator (IV-tPA) administration, but its therapeutic results on large-artery intracranial occlusive disease (LAICOD) are questionable. Authors analyzed the recanalization rate of IV-tPA therapy in LAICOD patients.

    Methods: A total of 202 patients with infused IV-tPA were included in this retrospective analysis. All patients, underwent brain CT-angiography as an initial image study and after IV-tPA administration, MRI was performed. And in 40 patients with failure of recanalization after IV-tPA, additional IA-Tx was attempted if the patient was within 6 hours from the symptom attack. Clinical outcomes were compared by recanalization rate, modified Rankin Scale (mRS), and hemorrhagic complication rate.

    Results: 119 patients were defined with LAICOD, 79 patients received IV-tPA only and 40 patients were given IV-tPA and additional IA-Tx. The recanalization rate of LAICOD patients after IV-tPA was 13.4% (16 out of 119 patients). Patient outcomes of recanalized patients after IV-tPA, showed a more favorable outcome (mRS=0~2, 73.3%) than non-recanalized patients (favorable outcome = 31.3%). Patients who underwent additional IA-Tx, showed 87.5% recanalization rate and these patients' mortality was significantly low than non-recanalized after IV-tPA administration (31.3% vs. 17.1%, p<0.05).

    Conclusions: From this study, the recanalization rate after IV-tPA on LAICOD patients was very low and non-recanalized patients' clinical outcomes were also poor. Authors would like to propose that IA-Tx might be considered as an additional treatment modality for LAICOD patients who didn't recanalized after IV-tPA administration.

    Patient Care: To improve the patients outcome, randomized control trial should be performed, which therapy, iv-tPA or IA-Tx is proper for large-artery intracranial occlusion patients. And dynamic images such as CT-angiograogy or MR-angiograohy should incluse as an initial evaluation image instead non-enhance CT.

    Learning Objectives: intravenous tPA administration is ineffective in larger vessel occluded acute stroke patients.


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