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E-161 Intra-arterial tissue plasminogen activator is a safe adjunctive therapy to mechanical thrombectomy
  1. M Anadani,
  2. S Ajinky,
  3. A Alawieh,
  4. A Chatterjee,
  5. J Vargas,
  6. R Turner,
  7. A Turk,
  8. M Chaudry,
  9. A Spiotta
  1. Neurology, Medical University of South Carolina, Charleston, SC

Abstract

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 during thrombectomy is scarce.

Objective To report the safety outcome of MT with IA tPA and compare it to MT without IA-tPA.

Methods We reviewed our prospectively maintained data and identified patients who received mechanical thrombectomy between 11/1/2014 to 4/1/2017. Collected variables included demographics, comorbidities, baseline NIHSS, procedural variables and outcome variables. Hemorrhagic transformation (HT) was divided into hemorrhagic infarction and parenchymal hemorrhage (PH) based on ECASS criteria. Functional outcome was assessed based on modified Rankin Scale (mRS).

Results Total of 408 patients were included in this study. 57 patients were treated with MT and IA tPA, and 351 were treated with MT alone. Median IA tPA dose was 5 mg (IQR,4–6). Both groups did not differ in baseline characteristics, comorbidities or admission NIHSS. Around 45% of patients achieved a favorable outcome (mRS ≤2) in both groups (p=0.97). The rate of any hemorrhagic complications and parenchymal hemorrhage (PH) did not differ between groups (any hemorrhage; 38.6% vs 35.9%; p=0.69, PH; 10.5% vs 12.3%; p=0.71).

Conclusion Intra-arterial tPA is a safe adjunctive therapy to mechanical thrombectomy.

Abstract E-161 Table 1

Baseline characteristics and clinical outcomes

ASPECT, Alberta stroke program early CT score; IV tPA, intravenous tissue plasminogen activator; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; PH, parenchymal hemorrhage; TICI, Thrombolysis in Cerebral Ischemia.

Disclosures M. Anadani: None. S. Ajinky: None. A. Alawieh: None. A. Chatterjee: None. J. Vargas: None. R. Turner IV: 1; C; Codman, Penumbra, Microvention, Pulsar Vascular Stock. 2; C; Codman, Covidien, Penumbra, Microvention, Blockade-Stocks, Pulsar Vascular Stock, Medtronic. 3; C; Codman, Covidien, Penumbra, Microvention, Blockade-Stocks, Pulsar Vascular Stock, Medtronic. A. Turk: 6; C; Codman Consulting, Honorarium, Speaker Bureau, Research Funding; Covidien Consulting, Honorarium, Speaker Bureau; Penumbra Consulting, Honorarium, Speaker Bureau, Research Grants; Microvention Consult. M. Chaudry: 6; C; Codman Consulting, Honorarium, Speaker Bureau, Research Funding; Covidien Consulting, Honorarium, Speaker Bureau; Penumbra Consulting, Honorarium, Speaker Bureau, Research Grants; Microvention Consult. A. Spiotta: 6; C; Penumbra Consulting, Honorarium, Speaker Bureau; Pulsar Vascular Consulting, Honorarium, Speaker Bureau; Microvention Consulting, Honorarium, Speaker Bureau, Research; Stryker Consulting, Honorarium.

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