Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion

Yinn Cher Ooi; Brian Behdad Miremadi; Faisal Mukarram; Naoki Kaneko; May Nour; Geoffrey Colby; Reza Jahan; Satoshi Tateshima; Gary Duckwiler; Jeffrey Saver; Viktor Szeder

doi:10.1016/j.wneu.2020.12.142

Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion

World Neurosurg. 2021 Apr:148:e321-e325. doi: 10.1016/j.wneu.2020.12.142. Epub 2021 Jan 11.

Authors

Affiliations

¹ Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA.
² Department of Neurology, Harbor UCLA Medical Center, Torrance, California, USA. Electronic address: miremadi_b@yahoo.com.
³ Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.
⁴ Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA.

PMID: 33444835
DOI: 10.1016/j.wneu.2020.12.142

Abstract

Objective: The goal of the present study was to determine the safety and efficacy of intravenous tissue plasminogen activator (IVT) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT).

Methods: We performed a retrospective analysis of prospectively collected data gathered during a 3-year period for all our patients with AIS and LVO. We analyzed the stroke outcomes and complications between patients who had received a combination of IVT and MT and those who had undergone MT only. Standardized selection criteria, including the uniform use of perfusion imaging, were used for selection for MT, irrespective of IVT administration.

Results: Of the patients who had received IVT, 10% had had successful reperfusion found at initial angiography and did not require MT. A door-to-puncture time within 1 hour of presentation was achieved in 19% of both groups. IVT+MT was not associated with an increased incidence of intracranial hemorrhage (IVT+MT, 47.1%; MT, 49%). Of the 73 patients in IVT+MT group, 8 had developed access-site hematomas compared with 9 of the 95 patients in the MT group (28.6% vs. 26.5%; P = 0.85). The IVT+MT group had a lower proportion of patients with a modified Rankin scale score of 5-6 at 90 days compared with the MT group (36% vs. 56%; P = 0.024). Both groups showed statistically similar proportions of patients with a Thrombolysis in Cerebral Infarction scale score of ≥2c (IVT+MT, 50%; MT, 43%; P = 0.58). The IVT+MT group had a greater proportion of patients with Thrombolysis in Cerebral Infarction scale score of 2c (IVT+MT, 29.6%; MT, 16.8%; P = 0.068).

Conclusions: Administration of IVT before MT to patients with AIS with LVO resulted in reperfusion before MT in 10% of patients, reduced the incidence of mortality and severe disability at 90 days, did not affect the door-to-puncture time, and was associated with a similar incidence of systemic and intracranial hemorrhage compared with MT only.

Keywords: Acute ischemic stroke; Large vessel occlusion; Mechanical thrombectomy; Reperfusion; Tissue plasminogen activator; tPA.

Publication types

Comparative Study

MeSH terms

Aged
Combined Modality Therapy
Comorbidity
Disability Evaluation
Female
Hematoma / etiology
Humans
Infusions, Intravenous
Intracranial Hemorrhages / etiology
Ischemic Stroke / complications
Ischemic Stroke / drug therapy*
Ischemic Stroke / therapy
Male
Mechanical Thrombolysis*
Prospective Studies
Retrospective Studies
Risk Factors
Thrombosis / etiology*
Time-to-Treatment
Tissue Plasminogen Activator / administration & dosage
Tissue Plasminogen Activator / adverse effects
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome
Vascular Patency

Substances

Tissue Plasminogen Activator