학술논문
SAFETY AND EFFICACY OF INTRA-ARTERIAL UROKINASE AFTER FAILED, UNSUCCESSFUL OR INCOMPLETE MECHANICAL THROMBECTOMY IN ANTERIOR CIRCULATION LARGE-VESSEL OCCLUSION STROKE
357
357
Document Type
Academic Journal
Author
Source
Clinical Neuroradiology. September 2019, Vol. 29 Issue S1, pS99, 2 p.
Subject
Language
English
ISSN
1869-1439
Abstract
Johannes Kaesmacher * (1), Sebastian Bellwald (2), Tomas Dobrocky (1), Thomas Meinel (2), Eike Immo Piechowiak (1), Martina Goeldlin (2), Christoph Kurmann (1), Mirjam Rachel Heldner (2), Simon Jung (2), [...]
Background: Administration of intra-arterial (IA) thrombolysis may help to improve reperfusion during or after incomplete mechanical thrombectomy (MT) in large-vessel occlusions (LVO) stroke patients. However, data on its safety and efficacy is scarce. Methods: Consecutive acute ischemic stroke patients of a prospective registry presenting with anterior circulation LVO stroke were analyzed (N = 1017). Patients who received additional IA Urokinase during or after MT (+/- intravenous tPA) were compared to those treated with MT (+/- intravenous tPA) only. Primary safety measures included asymptomatic and symptomatic intracranial hemorrhage (aICH and sICH) according to PROACT-II criteria, and all-cause mortality. Primary efficacy endpoints were angiographic reperfusion and Thrombolysis in Cerebral Infarction (TICI) improvement, together with functional independence at day 90 (defined as modified Rankin Scale [less than or equal to]2). Endpoints were assessed using multivariate logistic regression analyses adjusting for confounders underlying case selection. Results: Additional IA Urokinase was administered in 102 of 1017 patients (10.0%). The most common reason for administering IA Urokinase was incomplete reperfusion (TICI Discussion/Conclusion: In selected patients, adjunctive treatment with IA Urokinase during or after MT seems to be safe, without an increased risk of intracranial bleedings. Additionally, IA Urokinase harbors the potential to improve the reperfusion status of patients undergoing endovascular interventions and may thus improve outcomes.
Background: Administration of intra-arterial (IA) thrombolysis may help to improve reperfusion during or after incomplete mechanical thrombectomy (MT) in large-vessel occlusions (LVO) stroke patients. However, data on its safety and efficacy is scarce. Methods: Consecutive acute ischemic stroke patients of a prospective registry presenting with anterior circulation LVO stroke were analyzed (N = 1017). Patients who received additional IA Urokinase during or after MT (+/- intravenous tPA) were compared to those treated with MT (+/- intravenous tPA) only. Primary safety measures included asymptomatic and symptomatic intracranial hemorrhage (aICH and sICH) according to PROACT-II criteria, and all-cause mortality. Primary efficacy endpoints were angiographic reperfusion and Thrombolysis in Cerebral Infarction (TICI) improvement, together with functional independence at day 90 (defined as modified Rankin Scale [less than or equal to]2). Endpoints were assessed using multivariate logistic regression analyses adjusting for confounders underlying case selection. Results: Additional IA Urokinase was administered in 102 of 1017 patients (10.0%). The most common reason for administering IA Urokinase was incomplete reperfusion (TICI Discussion/Conclusion: In selected patients, adjunctive treatment with IA Urokinase during or after MT seems to be safe, without an increased risk of intracranial bleedings. Additionally, IA Urokinase harbors the potential to improve the reperfusion status of patients undergoing endovascular interventions and may thus improve outcomes.