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Intravenous versus combined (intravenous and intra-arterial) thrombolysis in acute ischemic stroke : A transcranial color-coded duplex sonography-guided pilot study
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 te...
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| Published in: | Stroke (1970) 2006-07, Vol.37 (7), p.1805-1809 |
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| container_end_page | 1809 |
| container_issue | 7 |
| container_start_page | 1805 |
| container_title | Stroke (1970) |
| container_volume | 37 |
| creator | SEKORANJA, Lucka LOULIDI, Jaouad YILMAZ, Hasan LOVBLAD, Karl TEMPERLI, Philippe COMELLI, Mario SZTAJZEL, Roman F |
| description | 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 |
| doi_str_mv | 10.1161/01.STR.0000227358.37094.46 |
| format | article |
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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<0.05). In the combined IV/IA therapy group (no recanalization after 30 minutes), 9/16 patients (56%) had a favorable outcome at 3 months. One symptomatic intracerebral hemorrhage occurred in each group.
Combined IV-IA versus IV thrombolysis guided by TCCD was feasible and safe. Recanalization after 30 minutes of IV thrombolysis led to a favorable outcome in 59% of the patients, provided TIBI flow grades were of 3 to 5. In the absence of early recanalization during IV thrombolysis, there was clinical benefit to proceed to IA therapy for a significative proportion of patients (56%).</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.0000227358.37094.46</identifier><identifier>PMID: 16763175</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>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</subject><ispartof>Stroke (1970), 2006-07, Vol.37 (7), p.1805-1809</ispartof><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-1af43056de181ed28ddccfb5698dafb42bd8a8e775aa7e936cce4bfe50a5de3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17920055$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16763175$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SEKORANJA, Lucka</creatorcontrib><creatorcontrib>LOULIDI, Jaouad</creatorcontrib><creatorcontrib>YILMAZ, Hasan</creatorcontrib><creatorcontrib>LOVBLAD, Karl</creatorcontrib><creatorcontrib>TEMPERLI, Philippe</creatorcontrib><creatorcontrib>COMELLI, Mario</creatorcontrib><creatorcontrib>SZTAJZEL, Roman F</creatorcontrib><title>Intravenous versus combined (intravenous and intra-arterial) thrombolysis in acute ischemic stroke : A transcranial color-coded duplex sonography-guided pilot study</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>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<0.05). In the combined IV/IA therapy group (no recanalization after 30 minutes), 9/16 patients (56%) had a favorable outcome at 3 months. One symptomatic intracerebral hemorrhage occurred in each group.
Combined IV-IA versus IV thrombolysis guided by TCCD was feasible and safe. Recanalization after 30 minutes of IV thrombolysis led to a favorable outcome in 59% of the patients, provided TIBI flow grades were of 3 to 5. In the absence of early recanalization during IV thrombolysis, there was clinical benefit to proceed to IA therapy for a significative proportion of patients (56%).</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography, Digital Subtraction</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Brain Ischemia - drug therapy</subject><subject>Carotid Artery, Internal - diagnostic imaging</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Humans</subject><subject>Infarction, Middle Cerebral Artery - drug therapy</subject><subject>Infarction, Middle Cerebral Artery - physiopathology</subject><subject>Infusions, Intra-Arterial</subject><subject>Infusions, Intravenous</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic</subject><subject>Nervous system</subject><subject>Neurology</subject><subject>Pharmacology. Drug treatments</subject><subject>Pilot Projects</subject><subject>Recombinant Proteins - administration & dosage</subject><subject>Recombinant Proteins - therapeutic use</subject><subject>Reperfusion</subject><subject>Severity of Illness Index</subject><subject>Thrombolytic Therapy - methods</subject><subject>Tissue Plasminogen Activator - administration & dosage</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Ultrasonic investigative techniques</subject><subject>Ultrasonography, Doppler, Color</subject><subject>Ultrasonography, Doppler, Transcranial</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><recordid>eNpNkd9qFDEUxoModq2-ggTBohcz5s8kk-ldKbYWCoLtfcgkZ7rRzGRMZor7Pj6o2XZhzUUO4fy-85HzIfSBkppSSb8QWt_d_6hJOYy1XKiat6Rr6ka-QBsqWFM1kqmXaEMI7yrWdN0JepPzzz3PlXiNTqhsJaet2KC_N9OSzCNMcc34EVIuxcax9xM4_Mn_1zSTw0_vyqQFkjfhM162qbAx7LLPpYmNXRfAPtstjN7ivKT4C_A5vsBFN2VbrqIrBiGmykZXPNw6B_iDc5ziQzLzdlc9rH7fmH2ISxmxut1b9GowIcO7Qz1Fd1df7y-_Vbffr28uL24ry5lcKmqGhhMhHVBFwTHlnLVDL2SnnBn6hvVOGQVtK4xpoePSWmj6AQQxwgE_RWfPU-cUf6-QFz2Wn0AIZoKyAC2VUF3HaAHPn0GbYs4JBj0nP5q005TofUKaUF0S0seE9FNCupFF_P7gsvYjuKP0EEkBPh4Ak60JQ9mZ9fnItR0jRAj-D4EHoFo</recordid><startdate>20060701</startdate><enddate>20060701</enddate><creator>SEKORANJA, Lucka</creator><creator>LOULIDI, Jaouad</creator><creator>YILMAZ, Hasan</creator><creator>LOVBLAD, Karl</creator><creator>TEMPERLI, Philippe</creator><creator>COMELLI, Mario</creator><creator>SZTAJZEL, Roman F</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060701</creationdate><title>Intravenous versus combined (intravenous and intra-arterial) thrombolysis in acute ischemic stroke : A transcranial color-coded duplex sonography-guided pilot study</title><author>SEKORANJA, Lucka ; LOULIDI, Jaouad ; YILMAZ, Hasan ; LOVBLAD, Karl ; TEMPERLI, Philippe ; COMELLI, Mario ; SZTAJZEL, Roman F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-1af43056de181ed28ddccfb5698dafb42bd8a8e775aa7e936cce4bfe50a5de3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiography, Digital Subtraction</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Brain Ischemia - diagnostic imaging</topic><topic>Brain Ischemia - drug therapy</topic><topic>Carotid Artery, Internal - diagnostic imaging</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Infarction, Middle Cerebral Artery - drug therapy</topic><topic>Infarction, Middle Cerebral Artery - physiopathology</topic><topic>Infusions, Intra-Arterial</topic><topic>Infusions, Intravenous</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic</topic><topic>Nervous system</topic><topic>Neurology</topic><topic>Pharmacology. Drug treatments</topic><topic>Pilot Projects</topic><topic>Recombinant Proteins - administration & dosage</topic><topic>Recombinant Proteins - therapeutic use</topic><topic>Reperfusion</topic><topic>Severity of Illness Index</topic><topic>Thrombolytic Therapy - methods</topic><topic>Tissue Plasminogen Activator - administration & dosage</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Ultrasonic investigative techniques</topic><topic>Ultrasonography, Doppler, Color</topic><topic>Ultrasonography, Doppler, Transcranial</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SEKORANJA, Lucka</creatorcontrib><creatorcontrib>LOULIDI, Jaouad</creatorcontrib><creatorcontrib>YILMAZ, Hasan</creatorcontrib><creatorcontrib>LOVBLAD, Karl</creatorcontrib><creatorcontrib>TEMPERLI, Philippe</creatorcontrib><creatorcontrib>COMELLI, Mario</creatorcontrib><creatorcontrib>SZTAJZEL, Roman F</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SEKORANJA, Lucka</au><au>LOULIDI, Jaouad</au><au>YILMAZ, Hasan</au><au>LOVBLAD, Karl</au><au>TEMPERLI, Philippe</au><au>COMELLI, Mario</au><au>SZTAJZEL, Roman F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intravenous versus combined (intravenous and intra-arterial) thrombolysis in acute ischemic stroke : A transcranial color-coded duplex sonography-guided pilot study</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2006-07-01</date><risdate>2006</risdate><volume>37</volume><issue>7</issue><spage>1805</spage><epage>1809</epage><pages>1805-1809</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>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<0.05). In the combined IV/IA therapy group (no recanalization after 30 minutes), 9/16 patients (56%) had a favorable outcome at 3 months. One symptomatic intracerebral hemorrhage occurred in each group.
Combined IV-IA versus IV thrombolysis guided by TCCD was feasible and safe. Recanalization after 30 minutes of IV thrombolysis led to a favorable outcome in 59% of the patients, provided TIBI flow grades were of 3 to 5. In the absence of early recanalization during IV thrombolysis, there was clinical benefit to proceed to IA therapy for a significative proportion of patients (56%).</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>16763175</pmid><doi>10.1161/01.STR.0000227358.37094.46</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Stroke (1970), 2006-07, Vol.37 (7), p.1805-1809 |
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| 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 |
| title | Intravenous versus combined (intravenous and intra-arterial) thrombolysis in acute ischemic stroke : A transcranial color-coded duplex sonography-guided pilot study |
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