Intra-Arterial vs Intra-Venous Thrombolysis for Anterior Cerebral Occlusion

Abstract

Background: The safety and effectiveness of intra-arterial thrombolysis (IAT) in comparison to intravenous thrombolysis (IVT) for the treatment of ischemic stroke is uncertain. Our study aims to assess and compare IAT to IVT for clinically relevant outcomes in patients with occlusion of the anterior cerebral circulation. Methods: Patients with acute ischemic stroke were enrolled for either treatment; those whose symptoms occurred within 4.5 hrs after stroke were treated with IVT, whereas those who presented <4.5 hrs but had contraindications to IVT or presented between 4.5 and 6 hrs were treated with IAT. Evaluated endpoints included: disability at 90 days as measured by the modified Rankin Scale (mRS), incidence of mortality, and incidence of symptomatic intracranial haemorrhage. Results: 78 patients with anterior cerebral circulation occlusion were included in the study (55 in IVT, 23 in IAT). After 90 days, 82.6% patients treated with IAT reached independence in comparison to 56.4% in the IVT group (P=0.028, RR=2.66, 95% CI: 1.10-7.04). The incidence of all intracranial haemorrhages in the IAT and IVT groups respectively were 30.4% and 12.7% (P=0.103, RR=2.391, 95% CI: 0.946-6.047); symptomatic intracranial haemorrhage occurred in 8.7% and 9.1% of patients (P=1.00, RR= 0.957, 95% CI: 0.200-4.579), and mortality in 8.7% and 16.4% (P=0.492, RR=1.882, 95% CI: 0.440-8.045). Conclusion: Results suggest that IAT is more effective than IVT in allowing patients to achieve independence. While inconclusive, the safety of IAT within 6 hrs is comparable to IVT within 4.5 hrs.RÉSUMÉ: Thrombolyse intra-artérielle versus intraveineuse pour traiter l'occlusion de l'artère cérébrale antérieure. Contexte : La sécurité et l'efficacité de la thrombolyse intra-artérielle (TIA) comparée à la thrombolyse intraveineuse (TIV) dans le traitement de l'accident vasculaire cérébral (AVC) sont mal connues. Le but de cette étude était d'évaluer et de comparer la TIA et la TIV quant aux résultats cliniques pertinents chez les patients atteints d'une occlusion de la circulation cérébrale antérieure. Méthodes : Des patients atteints d'un AVC ischémique aigu ont été inclus dans cette étude. Ceux dont les symptômes duraient depuis 4,5 heures ou moins étaient traités par TIV alors que ceux dont les symptômes duraient depuis moins de 4,5 heures mais qui avaient des contre-indications à la TIV ou qui se présentaient entre 4,5 et 6 heures ont reçu une TIA. Les résultats évalués étaient les suivants: l'invalidité après 90 jours selon l'échelle de Rankin modifiée, l'incidence de mortalité et l'incidence d'hémorragie intracrânienne symptomatique. Résultats : Soixante-dix-huit patients atteints d'occlusion de la circulation cérébrale antérieure ont été inclus dans l'étude, soit 55 dans le groupe TIV et 23 dans le groupe TIA. Après 90 jours, 82,6% des patients traités par TIA étaient redevenus indépendants par rapport à 56,4% des patients traités par TIV (p = 0,028; RR = 2,66; IC à 95% de 1,10 à 7,04). L'incidence d'hémorragie intracrânienne d...

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

“…In the present study, NIHSS score at admission was also found to be an independent risk factor for predicting the poor prognosis of thrombolysed patients with acute ischemic stroke. In agreement with our results, high NIHSS score at admission were also found to play a role in poor outcome in thrombolysed patients with ischemic stroke (Ryu et al, 2010;Smith et al, 2010;Zhang et al, 2010). Furthermore, we observed that severity degree of neurological deficit at admission was associated with the prognosis in the dehydrated patients.…”

Intra-Arterial Thrombolysis vs. Standard Treatment or Intravenous Thrombolysis in Adults with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

“…screening. After first-level screening, 33 articles were included for full-text screening of which 27 were excluded because they were not an RCT (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), comparator included IAT (37), no comparator (38)(39)(40), or active treatment was confounded by IVT (13). The full text of two articles could not be retrieved as attempts to contact the authors were unsuccessful (41,42).…”

Efficacy and Safety of Endovascular Treatment versus Intravenous Thrombolysis for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

“…As compared with control group, endovascular treatment is associated with a higher probability of recanalization [7],[8]. However, the previous related studies tended to show different results when it compared with intravenous thrombolysis [9],[10][11][12]. Recommendations based on the results of individual trials may be misleading, and the previous review include only two small-scale (81 patients) studies [13].…”