Intra-arterial Thrombolysis to Target Occlusions in Distal Arteries and the Microcirculation

Khatri, Pooja

doi:10.1001/jama.2021.25014

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…Thus, it was relatively easy to achieve vascular recanalization with IAT or MT. Another notable finding in the current study is the very high rate (93.7%) of 90-day mRS 0-2 in the IAT alone group, which may be because IAT not only could achieve successful recanalization but also improved the distal microcirculation reperfusion ( 10 ).…”

Section: Discussionmentioning

confidence: 61%

“…Unlike MT, which has an invasive characteristic concerning arterial wall damage, non-MT treatment, such as intra-arterial thrombolysis (IAT), seems to be an appropriate treatment option for LVO with minor stroke. Additionally, IAT had a better rate of recanalization when compared with standard medical treatment ( 9 ) and could also enhance the microcirculatory reperfusion of the target occlusion artery ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Intra-Arterial Thrombolysis Vs. Mechanical Thrombectomy in Acute Minor Ischemic Stroke Due to Large Vessel Occlusion

et al. 2022

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BackgroundThe efficacy and safety of mechanical thrombectomy (MT) in acute large vessel occlusion (LVO) patients with minor stroke (NIHSS ≤ 5) remains undetermined. We aimed to compare the efficacy and safety of intra-arterial thrombolysis (IAT) alone vs. MT for LVO patients with minor stroke.MethodsPatients were selected from the Acute Ischemic Stroke Cooperation Group of Endovascular Treatment (ANGEL) registry, a prospective multicenter registry study, and divided into MT and IAT alone groups. We compared the outcome measures between the two groups, including 90-day functional outcome evaluated by the modified Rankin Scale (mRS), the final recanalization level, intracranial hemorrhage, and mortality within 90-days by logistic regression models with adjustment. Besides the conventional multivariable analysis, we performed a sensitivity analysis by adjusting the propensity score to confirm our results. The propensity score was derived using a logistic regression model.ResultsOf the 120 patients, 63 received IAT alone and 57 received MT as the first-line treatment strategy. As compared to MT group, patients in the IAT alone group were associated with a higher chance of 90-day mRS 0-2 [93.7% vs. 71.9%, odds ratio (OR) = 4.75, 95% confidence interval (CI): 1.20–18.80, P = 0.027], a high chance of 90-day mRS 0-3 (96.8% vs. 86.7%, OR = 11.35, 95% CI: 1.93–66.86, P = 0.007), a shorter median time from puncture to recanalization (PTR) (60 min vs. 100 min, β = −63.70, 95% CI: −81.79– −45.61, P < 0.001), a lower chance of any intracranial hemorrhage (ICH) within 48 h (3.2% vs. 19.3%, OR = 0.15, 95% CI: 0.03–0.79, P = 0.025), and a lower chance of mortablity within 90 days (1.6% vs. 9.2%, OR = 0.05, 95% CI: 0.01–0.57, P = 0.016). Similarly, the sensitivity analysis showed the robustness of the primary analysis.ConclusionsCompared with MT, IAT may improve 90-day clinical outcomes with decreased ICH rate and mortality in LVO patients with minor stroke.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Intra-Arterial Thrombolysis Vs. Mechanical Thrombectomy in Acute Minor Ischemic Stroke Due to Large Vessel Occlusion

et al. 2022

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“…Theoretically, the vascular recanalization rate should exceed that of intravenous thrombolysis, and its bleeding risk is reduced, but arterial thrombolysis requires vascular intervention, and the technical requirements of operators are demanding with huge operation difficulty, and difficult to popularize. [12,13] Since its clinical approval in 1996, intravenous thrombolysis has benefited an increasing number of patients with acute ischemic stroke, and most guidelines now recommend intravenous thrombolysis as the preferred treatment for early vascular recanalization. [14][15][16] Alteplase is a thrombolytic medication whose primary constituent is glycoprotein, comprised of 526 amino acids.…”

Section: Introductionmentioning

confidence: 99%

Effects of alteplase and aspirin on functional outcomes in patients with acute ischemic stroke and mild non-disabling neurological deficit

Sun,

Hao,

Song

et al. 2024

Medicine

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Investigate the effect of Alteplase and Aspirin on the functional outcomes of patients with acute ischemic stroke with mild non-disabling neurological deficit. In this single-center, randomized controlled study, we selected 60 patients with acute ischemic stroke with mild non-disabling neurological deficit admitted to our hospital from January 2021 to January 2022, and randomly divided them into the study group (n = 30) and the control group (n = 30), the control group was given the Aspirin treatment, the study group was given the Alteplase treatment, and the changes in neurological recovery, daily living ability, exercise ability, balance ability, cognitive function, and short-term prognosis outcomes were observed in these 2 groups. The factors influencing the short-term outcome of Alteplase therapy in patients with acute ischemic stroke were analyzed. The National Institutes of Health Neurological Deficit Score (NIHSS) scores at T1 and T2 of the study group were lower than those in the control group, but the scores of Barthel indicators (BI), Fugl-Meyer Motor Assessment Scale (FMA), Berg Balance Scale (BBS) and Montreal Cognitive Assessment Scale (MoCA) of the study group were higher than those in the control group, and the difference was statistically significant (P < .05). The short-term prognostic outcomes of these 2 groups were not significantly different (P > .05). The effect of the use of Alteplase or Aspirin on short-term functional outcomes in patients with acute ischemic stroke and mild non-disabling neurological deficit is not much different.

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“…The introduction into clinical practice of endovascular mechanical thrombectomy (MT) has brought better results in patients with ischemic stroke from large vessel occlusion (LVO) in the anterior circulation in whom therapy is started 4.5–5 hours after symptoms onset 1–3. Controversies exist about the usefulness of intravenous thrombolysis (IVT) before MT in patients with atrial fibrillation (AF).…”

mentioning

confidence: 99%

“…It is possible that a substantial volume of brain tissue could have been already irreversibly injured in some patients by the time reperfusion occurs. The longer the time of cerebral ischemia the higher the possibility of endothelial damage with consequent reduced nitrogen dioxide (NO 2 ) production and vasoconstriction, and impaired antithrombotic function 1 2…”

mentioning

confidence: 99%

Intravenous thrombolysis before mechanical thrombectomy in patients with atrial fibrillation

Bozzani

Arici

Ragni

et al. 2022

J NeuroIntervent Surg

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Intra-arterial Thrombolysis to Target Occlusions in Distal Arteries and the Microcirculation

Cited by 7 publications

References 16 publications

Intra-Arterial Thrombolysis Vs. Mechanical Thrombectomy in Acute Minor Ischemic Stroke Due to Large Vessel Occlusion

Intra-Arterial Thrombolysis Vs. Mechanical Thrombectomy in Acute Minor Ischemic Stroke Due to Large Vessel Occlusion

Effects of alteplase and aspirin on functional outcomes in patients with acute ischemic stroke and mild non-disabling neurological deficit

Intravenous thrombolysis before mechanical thrombectomy in patients with atrial fibrillation

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