Intravenous versus combined (intravenous and intra-arterial) thrombolysis in acute ischemic stroke : A transcranial color-coded duplex sonography-guided pilot study

• Published in: Stroke (1970) 2006-07, Vol.37 (7), p.1805-1809
• Main Authors: SEKORANJA, Lucka, LOULIDI, Jaouad, YILMAZ, Hasan, LOVBLAD, Karl, TEMPERLI, Philippe, COMELLI, Mario, SZTAJZEL, Roman F
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - diagnostic imaging; Brain Ischemia - drug therapy; Carotid Artery, Internal - diagnostic imaging; Feasibility Studies; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Humans; Infarction, Middle Cerebral Artery - drug therapy; Infarction, Middle Cerebral Artery - physiopathology; Infusions, Intra-Arterial; Infusions, Intravenous; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Monitoring, Physiologic; Nervous system; Neurology; Pharmacology. Drug treatments; Pilot Projects; Recombinant Proteins - administration & dosage; Recombinant Proteins - therapeutic use; Reperfusion; Severity of Illness Index; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000227358.37094.46

Determine feasibility and safety of intravenous (IV) versus combined (IV-IA [intra-arterial]) thrombolysis guided by transcranial color-coded duplex sonography (TCCD). Thirty-three patients eligible for IV thrombolysis, within 3 hours of onset of symptoms, with occlusion in middle cerebral artery territory (TCCD monitoring, thrombolysis in brain ischemia [TIBI] flow grade [0-3]), underwent IV thrombolysis (tissue plasminogen activator, 0.9 mg/kg). In case of recanalization (modification of TIBI score > or =1) after 30 minutes IV thrombolysis was continued over 1 hour; otherwise, it was discontinued, with subsequent IA thrombolysis. Recanalization was determined by TIBI (TCCD) and angiographically by thrombolysis in myocardial infarction (TIMI) flow grades. Clinical outcome measures were assessed at baseline, 24 hours (NIHSS) and 3 months (modified Rankin Scale). In the IV group, 10/17 patients (59%) with complete or partial recanalization after 30 minutes had a favorable outcome at 3 months (modified Rankin Scale 0 to 2). TIBI flow grades 3 to 5 after 30 minutes of IV thrombolysis predicted a good prognosis compared with TIBI grades 1 to 2 (P