Intra-arterial adjuvant tirofiban after unsuccessful intra-arterial thrombolysis of acute ischemic stroke: preliminary experience in 16 patients

• Published in: Neuroradiology 2011-10, Vol.53 (10), p.779-785
• Main Authors: Kwon, Jee-Hyun, Shin, Shang Hun, Weon, Young Cheol, Hwang, Jae Cheol, Baik, Seung Kug
• Format: Article
• Language: English
• Subjects: Adjuvants; Adult; Age; Aged; Aged, 80 and over; Angiography; Biological and medical sciences; Blood clots; Brain Ischemia - drug therapy; Brain Ischemia - pathology; Brain Ischemia - physiopathology; Cerebral Hemorrhage - prevention & control; Cerebral infarction; Cerebrospinal fluid. Spinal cord. Spinal roots. Spinal nerves; Clinical outcomes; Combined Modality Therapy; Drug therapy; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Hemorrhage; Humans; Imaging; Inhibitor drugs; Injections, Intra-Arterial; Injections, Intravenous; Interventional Neuroradiology; Investigative techniques, diagnostic techniques (general aspects); Ischemia; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Nervous system; Neuroimaging; Neurology; Neuroradiology; Neurosciences; Neurosurgery; plasminogen; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; Recovery of Function - drug effects; Retrospective Studies; Stroke; Stroke - drug therapy; Stroke - pathology; Stroke - physiopathology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; t-Plasminogen activator; thrombolysis; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Tyrosine - administration & dosage; Tyrosine - analogs & derivatives; Tyrosine - therapeutic use; u-Plasminogen activator; Urokinase-Type Plasminogen Activator - administration & dosage; Urokinase-Type Plasminogen Activator - therapeutic use; Veins & arteries
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-011-0939-y

Introduction Intra-arterial (IA) thrombolysis with plasminogen activator is well-known, but the use of IA tirofiban as an adjuvant for IA thrombolysis is not well-known. We investigated the feasibility of IA tirofiban as an adjuvant after unsuccessful IA recanalization with urokinase (UK) for acute ischemic stroke. Methods We retrospectively analyzed all 16 consecutive patients (11 men and five women; mean age, 61.3 years; range, 36–85 years) who were treated with IA tirofiban after isolated IA thrombolysis with UK or bridging therapy with systemic recombinant tissue plasminogen activator (rt-PA; 0.6 mg/Kg) and IA UK for acute ischemic stroke. Outcome measures included angiographic recanalization (thrombolysis in cerebral infarction, TICI), symptomatic and asymptomatic intracerebral hemorrhage (ICH), mortality, and functional independence at 3 months (modified Rankin Scale, 0–2). Results Among the 16 patients treated with IA tirofiban as an adjuvant, 10 patients had conventional dose (