PT  - JOURNAL ARTICLE
AU  - Raul G Nogueira
AU  - Albert J Yoo
AU  - Shihab Masrur
AU  - Leonardo M Batista
AU  - Reza Hakimelahi
AU  - Joshua A Hirsch
AU  - Lee H Schwamm
TI  - Safety of full-dose intravenous recombinant tissue plasminogen activator followed by multimodal endovascular therapy for acute ischemic stroke
AID  - 10.1136/neurintsurg-2012-010376
DP  - 2013 Jul 01
TA  - Journal of NeuroInterventional Surgery
PG  - 298--301
VI  - 5
IP  - 4
4099  - http://jnis.bmj.com/content/5/4/298.short
4100  - http://jnis.bmj.com/content/5/4/298.full
SO  - J NeuroIntervent Surg2013 Jul 01; 5
AB  - Background and purpose The optimal management of stroke patients who fail treatment with intravenous recombinant tissue plasminogen activator (rt-PA) remains unknown. A study was undertaken to establish whether treatment with a standard intravenous t-PA dose (0.9 mg/kg) followed by multimodal endovascular therapy would have a similar safety profile to reduced dose (0.6 mg/kg) bridging therapy. Methods A retrospective analysis was performed of a prospectively collected database. All patients treated with full-dose t-PA and endovascular therapy were included. The primary safety endpoints included ECASS-III symptomatic intracranial hemorrhage (sICH) and ECASS parenchymal hematomas (PH). Secondary safety endpoints included severe systemic bleeding and 90-day mortality. Clinical efficacy endpoints included rates of recanalization (TICI 2–3), ambulation at hospital discharge and 90-day independent outcomes (mRS 0–2). Results 106 consecutive patients (mean age 69±17 years; mean baseline NIH Stroke Scale 17.8±4.8; 55% women; occlusion sites: MCA-M1 60.4%; MCA-M2 6.6%; ICA-T 19.8%; tandem cervical ICA+MCA-M1 7.5%; basilar artery 5.7%) were identified over a 10-year period. The sICH rate was 8.5% and the PH-1, PH-2 and subarachnoid hemorrhage rates were 2.8%, 8.5% and 2.8%, respectively. There were two (1.9%) severe groin hematomas. The recanalization rate was 66%. At hospital discharge, 41.4% of the patients were ambulatory. The rate of independent functional outcomes at 90 days was 24%; however, this sample is biased since nearly all deaths were captured but detailed 90-day functional outcomes were missing in 27 patients. The 90-day death rate was 32.4%. Conclusion Combined treatment with full-dose intravenous rt-PA followed by multimodal endovascular therapy seems to be associated with similar rates of sICH to that of bridging therapy with reduced rt-PA dosage.