Intravenous r-tPA Dose Influence on Outcome after Middle Cerebral Artery Ischemic Stroke Treatment by Mechanical Thrombectomy

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2020-07, Vol.56 (7), p.357
• Main Authors: Kurminas, Marius, Berūkštis, Andrius, Misonis, Nerijus, Blank, Karmela, Tamošiūnas, Algirdas Edvardas, Jatužis, Dalius
• Format: Article
• Language: English
• Subjects: Aged; bridging therapy; Dose-Response Relationship, Drug; Female; Humans; Infarction, Middle Cerebral Artery - drug therapy; Infarction, Middle Cerebral Artery - physiopathology; Ischemic Stroke - drug therapy; Ischemic Stroke - physiopathology; Male; Middle Aged; Middle Cerebral Artery; patient outcome assessment; stroke; thrombectomy; thrombolysis; Thrombolytic Therapy - adverse effects; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - pharmacology; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina56070357

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. 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). Baseline characteristics and functional outcome at 90 days did not differ between the bridging and direct MTE groups. Shorter MTE procedure and hospitalization time ( = 0.025 and = 0.036, respectively) were observed in the direct MTE group. An IVT treatment subgroup analysis showed higher rates of symptomatic ICH ( < 0.001) and longer intervals between imaging to MTE ( = 0.005) in the full r-tPA dose group. In patients with an MCA stroke, direct MTE seems to be a safe and equally effective 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.