Title Intravenous r-tPA dose influence on outcome after middle cerebral artery ischemic stroke treatment by mechanical thrombectomy /
Authors Kurminas, Marius ; Berūkštis, Andrius ; Misonis, Nerijus ; Blank, Karmela ; Tamošiūnas, Algirdas Edvardas ; Jatužis, Dalius
DOI 10.3390/medicina56070357
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Is Part of Medicina.. Kaunas; Basel : LSMU ; MDPI AG. 2020, vol. 56, no. 7, art. no 357, p. [1-11].. ISSN 1010-660X. eISSN 1648-9144
Keywords [eng] patient outcome assessment ; stroke ; thrombolysis ; thrombectomy ; bridging therapy
Abstract [eng] Background and Objectives: Pretreatment with intravenous thrombolysis (IVT) is still recommended in all eligible acute ischemic stroke patients with large-vessel occlusion before mechanical thrombectomy (MTE). However, the added value and safety of bridging therapy versus direct MTE remains controversial. We aimed at evaluating the influence of r-tPA dose level in patients with middle cerebral artery (MCA) occlusion treated with MTE. Materials and Methods: We prospectively compared clinical and radiological outcomes in 38 bridging patients, with 65 receiving direct MTE for MCA stroke admitted to Vilnius University Hospital Santaros Clinics. Following our protocol, r-tPA infusion was stopped just before MTE in the operating room. Therefore, we divided all bridging patients into three groups according to the amount of r-tPA they received: bolus, partial dose or full dose. Functional independence at 90 days was assessed by a modified Rankin Scale score, i.e., from 0–2. The safety outcomes included 90-day mortality and any intracerebral hemorrhage (ICH). Results: Baseline characteristics and functional outcome at 90 days did not di er between the bridging and direct MTE groups. Shorter MTE procedure and hospitalization time (p = 0.025 and p = 0.036, respectively) were observed in the direct MTE group. An IVT treatment subgroup analysis showed higher rates of symptomatic ICH (p < 0.001) and longer intervals between imaging to MTE (p = 0.005) in the full r-tPA dose group. Conclusions: In patients with an MCA stroke, direct MTE seems to be a safe and equally e ective as bridging therapy. The optimal r-tPA dose remains unclear. Randomized trials are needed to accurately evaluate the added value of r-tPA in patients treated with MTE.
Published Kaunas; Basel : LSMU ; MDPI AG
Type Journal article
Language English
Publication date 2020
CC license CC license description