Document Detail


Mechanical clot disruption following intravenous recombinant tissue plasminogen activator administration in non-responders.
MedLine Citation:
PMID:  20339266     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The efficacy of selecting non-responders to intravenous recombinant tissue plasminogen activator (rt-PA) for mechanical clot disruption (MCD) was investigated based on cerebral angiography in the acute stage following rt-PA therapy. rt-PA therapy using 0.6 mg/kg was performed in eligible patients within 3 hours of onset. Patients who did not show recanalization on cerebral angiography 1 hour after rt-PA initiation immediately underwent MCD. Clinical outcome was evaluated by National Institutes of Health Stroke Scale (NIHSS) score at baseline, 24 hours, and 1 month, and by modified Rankin scale (mRS) score at 3 months. Eighteen patients were initially treated with intravenous rt-PA, with mean time from stroke onset to rt-PA therapy of 120 +/- 27 minutes. Eight of these patients underwent MCD. Seven of these eight patients had complete recanalization. Time to recanalization by percutaneous transluminal angioplasty from stroke onset was 258 +/- 59 minutes. Final recanalization was achieved in 16 of the 18 patients. Baseline NIHSS score improved significantly at 1 month (median from 22.5 to 4). Twelve of the 18 patients treated according to our protocol were classified as independent (mRS scores 0-2). No patients had symptomatic hemorrhage. MCD for non-responders determined by cerebral angiography at the end of intravenous rt-PA infusion can decrease the time to recanalization and improve recanalization rates, leading to good clinical outcome after acute stroke.
Authors:
Taichiro Kawakami; Yuzo Terakawa; Takashi Tsuruno; Takaho Murata; Akimasa Nishio; Kenji Ohata
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurologia medico-chirurgica     Volume:  50     ISSN:  1349-8029     ISO Abbreviation:  Neurol. Med. Chir. (Tokyo)     Publication Date:  2010  
Date Detail:
Created Date:  2010-03-26     Completed Date:  2010-07-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400775     Medline TA:  Neurol Med Chir (Tokyo)     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  183-91     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan. taichiro@db4.so-net.ne.jp
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aged, 80 and over
Angioplasty, Balloon*
Brain Ischemia / therapy
Cerebral Angiography
Combined Modality Therapy
Female
Fibrinolytic Agents / administration & dosage*
Follow-Up Studies
Humans
Injections, Intravenous
Male
Middle Aged
Patient Selection
Recombinant Proteins
Stroke / therapy*
Thrombolytic Therapy / methods*
Time Factors
Tissue Plasminogen Activator / administration & dosage*
Treatment Failure
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Recombinant Proteins; EC 3.4.21.68/Tissue Plasminogen Activator

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