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Clinical results of intraarterial thrombolysis according to tPA administration and perfusion/diffusion mismatching

  • Clinical Article - Vascular
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Abstract

Background

IA-Tx and advanced dynamic imaging studies have been adopted for ischemic stroke patient treatment. Many patients are treated with IV-tPA, but this treatment is not always feasible. In this study, IA-Tx was used for patients for whom IV-tPA was not indicated or when IV-tPA did not result in recanalization.

Methods

A total of 156 patients treated with IA-Tx were retrospectively reviewed. Of these, 72 patients were treated with a full dose of IV-tPA before receiving the IA-Tx; the remaining 84 patients only received IA-Tx. An initial imaging study using CTA and acute stroke MRI followed. Patients’ demographics and clinical results were recorded and compared according to P/D mismatching and IV-tPA.

Results

Among P/D-mismatched patients, the recanalization rate was 80 % and the symptomatic intracranial hemorrhage rate was 14.5 %, while among P/D-matched patients, the rates were 63 % and 41.3 % respectively (p < 0.05). A favorable clinical outcome occurred in 49.1 % of P/D-mismatched, but only in 21.7 % of P/D-matched patients (p < 0.05). Among patients who were treated with IV-tPA before undergoing IA-Tx, the recanalization rate was 79.2 % and the sICH rate was 27.8 %, while it was 71.4 % and 17.9 % in patients who did not receive IV-tPA (p < 0.05).

Conclusions

Patients who have P/D mismatching and are treated with IA-Tx have higher recanalization rates and a greater probability of a favorable outcome than patients who have P/D matching and receive IA-Tx. For patients who do not undergo successful recanalization after IV-tPA or who are not indicated for IV-tPA, the authors recommend IA-Tx after undergoing appropriate imaging evaluation.

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Acknowledgments

We appreciate the grammatical review of our manuscript by Ann C. Rice, PhD, of Virginia Commonwealth University, Richmond, VA, USA.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Funding

This research was supported by a grant from the Catholic Institute of Cell Therapy in 2013

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Authors and Affiliations

  1. Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 65-1, Kumoh-dong, Uijeongbu-City, Gyeonggi-do, 480-130, Korea

    Tae-Kyu Lee, Do-Sung Yoo & Shin-Soo Jun

  2. Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Yoo-Dong Won, Young-Joo Kim & Chang-Woo Chun

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  1. Yoo-Dong Won
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Correspondence to Do-Sung Yoo.

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Won, YD., Lee, TK., Kim, YJ. et al. Clinical results of intraarterial thrombolysis according to tPA administration and perfusion/diffusion mismatching. Acta Neurochir 157, 389–398 (2015). https://doi.org/10.1007/s00701-014-2341-0

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  • DOI: https://doi.org/10.1007/s00701-014-2341-0

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