Neurocritical Care

, Volume 11, Issue 1, pp 76–81

IV vs. IA TPA in Acute Ischemic Stroke with CT Angiographic Evidence of Major Vessel Occlusion: A Feasibility Study

Authors

    • UNC Stroke Center, Department of NeurologyUniversity of North Carolina
  • David Y. Huang
    • UNC Stroke Center, Department of NeurologyUniversity of North Carolina
  • Omid Akhavan
    • UNC Stroke Center, Department of NeurologyUniversity of North Carolina
  • Susan Wilson
    • UNC Stroke Center, Department of NeurologyUniversity of North Carolina
  • Piero Verro
    • University of California Davis
  • Sten Solander
    • Department of RadiologyUniversity of North Carolina
Original Article

DOI: 10.1007/s12028-009-9204-1

Cite this article as:
Sen, S., Huang, D.Y., Akhavan, O. et al. Neurocrit Care (2009) 11: 76. doi:10.1007/s12028-009-9204-1

Abstract

Background and Aims

Studies suggest that stroke patients with thrombus in a major cerebral vessel respond less favorably to intravenous (IV) thrombolysis. The purpose of this study was to test the feasibility of a protocol comparing IV versus intra-arterial (IA) recombinant tissue plasminogen activator (TPA) in an acute ischemic stroke with major vessel occlusion.

Methods

Consecutive ischemic stroke patients presenting <3 h from symptom onset with major vessel occlusion on CT angiogram (CTA) were randomly assigned to IV TPA (per NINDS protocol) or IA TPA (22 mg over 2 h). Demographics, times to presentation and thrombolysis, presenting NIH stroke scale (NIHSS) and 90-day NIHSS, Barthel Index, and modified Rankin Scale were recorded. CT-scans at 24-h were reviewed for presence of hemorrhage. Recanalization was determined by post-procedure MR angiograms, which are obtained the day after thrombolytic therapy.

Results

Seven patients (median NIHSS = 16) were randomized to IV (N = 4) or IA (N = 3) TPA. There were no significant differences in the presentation NIHSS, time to presentation, or time to treatment between the two groups. Hemorrhage was noted in one patient in the IA group (asymptomatic) and one patient in the IV group (symptomatic). Recanalization was seen in all patients treated with IA TPA and none treated with IV TPA (P = 0.03, Fisher’s Exact test).

Conclusions

We found that it is feasible to conduct a trial comparing IV vs. IA TPA in ischemic stroke patients with major vessel occlusion presenting <3 h from onset. Patients treated with IA TPA showed a trend toward higher rate of recanalization. A larger trial may be designed to test safety and effectiveness of IA TPA in this specific group of stroke patients.

Keywords

ThrombolysisStrokeCT angiogramIntra-arterial

Copyright information

© Humana Press Inc. 2009