Adjuvant intra-arterial rt-PA injection at the initially deployed solitaire stent enhances the efficacy of mechanical thrombectomy in acute ischemic stroke
Both intra-arterial recombinant tissue plasminogen activator (rt-PA) and stent retrieval are effective for treating acute ischemic stroke. The goal of this study was to evaluate the effectiveness of stent retrieval combined with intra-arterial rt-PA administration via micro-catheter (called the comp...
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| Veröffentlicht in: | Journal of the neurological sciences 2018-03, Vol.386, p.69-73 |
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| creator | Yi, Ting-Yu Chen, Wen-Huo Wu, Yan-Min Zhang, Mei-Fang Lin, Ding-Lai Lin, Xiao-Hui |
| description | Both intra-arterial recombinant tissue plasminogen activator (rt-PA) and stent retrieval are effective for treating acute ischemic stroke. The goal of this study was to evaluate the effectiveness of stent retrieval combined with intra-arterial rt-PA administration via micro-catheter (called the complex technique) in acute ischemic stroke.
A retrospective analysis was performed of 93 consecutive patients treated between 2015 and 2017 for occlusions of the intracranial large artery using the complex technique (n=37) or stent retrieval alone (n=56) in our stroke center. Data on procedure duration, number of passes, and angiographic findings were collected. Successful recanalization was defined as the accomplishment of grade 3 or 2b modified Treatment in Cerebral Ischemia recanalization in 1 or 2 passes.
Compared to the stent retrieval group, complex technique group had a higher successful revascularization rate with 1 or 2 passes with the stent retriever (81.1% versus 51.8%, P=0.004), a shorter procedure time (59±34min versus 94±56min, P |
| doi_str_mv | 10.1016/j.jns.2018.01.012 |
| format | Article |
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A retrospective analysis was performed of 93 consecutive patients treated between 2015 and 2017 for occlusions of the intracranial large artery using the complex technique (n=37) or stent retrieval alone (n=56) in our stroke center. Data on procedure duration, number of passes, and angiographic findings were collected. Successful recanalization was defined as the accomplishment of grade 3 or 2b modified Treatment in Cerebral Ischemia recanalization in 1 or 2 passes.
Compared to the stent retrieval group, complex technique group had a higher successful revascularization rate with 1 or 2 passes with the stent retriever (81.1% versus 51.8%, P=0.004), a shorter procedure time (59±34min versus 94±56min, P<0.001), fewer passes of the stent retriever (1.8±1.1 versus 2.5±1.4, P=0.012), a better prognosis (70.3% versus 48.2%, P=0.035), a lower embolic complication rate (18.9% versus 39.3%, P=0.038), similar mortality (13.5% versus 21.4%, P=0.334) and similar intracranial hemorrhage symptoms (2.7% versus 12.5%, P=0.204). Intra-arterial rt-PA administration was an independent negative predictor of procedure time (OR=−0.292, P=0.003).
Mechanical thrombectomy utilizing stent retrieval combined with intra-arterial rt-PA administration in the anterior circulation of acute ischemic stroke patients improved the angiographic results and shortened the procedure duration without increasing adverse events.
•Stent retrieval combined with intra-arterial rt-PA administration (complex technique) shortened the procedure duration.•Complex technique decreases the likelihood of embolic event.•Complex technique increases the likelihood of good prognosis.</description><identifier>ISSN: 0022-510X</identifier><identifier>EISSN: 1878-5883</identifier><identifier>DOI: 10.1016/j.jns.2018.01.012</identifier><identifier>PMID: 29406970</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Acute ischemic stroke ; Aged ; Brain Ischemia - complications ; Cerebral Infarction - diagnostic imaging ; Cerebral Infarction - etiology ; Embolic event ; Female ; Fibrinolytic Agents - administration & dosage ; Humans ; Injections, Intra-Arterial - methods ; Intra-arterial thrombolysis ; Magnetic Resonance Angiography ; Male ; Mechanical thrombectomy ; Middle Aged ; Retrospective Studies ; Statistics, Nonparametric ; Stents ; Stroke - diagnostic imaging ; Stroke - etiology ; Stroke - therapy ; Thrombectomy - methods ; Tissue Plasminogen Activator - administration & dosage ; Tomography Scanners, X-Ray Computed ; Treatment Outcome</subject><ispartof>Journal of the neurological sciences, 2018-03, Vol.386, p.69-73</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-386f2bb73c7f3f80d13a18c78f32cae008f85a2e6a5353523d6a4d0600577cf13</citedby><cites>FETCH-LOGICAL-c353t-386f2bb73c7f3f80d13a18c78f32cae008f85a2e6a5353523d6a4d0600577cf13</cites><orcidid>0000-0002-7031-8917</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jns.2018.01.012$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29406970$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yi, Ting-Yu</creatorcontrib><creatorcontrib>Chen, Wen-Huo</creatorcontrib><creatorcontrib>Wu, Yan-Min</creatorcontrib><creatorcontrib>Zhang, Mei-Fang</creatorcontrib><creatorcontrib>Lin, Ding-Lai</creatorcontrib><creatorcontrib>Lin, Xiao-Hui</creatorcontrib><title>Adjuvant intra-arterial rt-PA injection at the initially deployed solitaire stent enhances the efficacy of mechanical thrombectomy in acute ischemic stroke</title><title>Journal of the neurological sciences</title><addtitle>J Neurol Sci</addtitle><description>Both intra-arterial recombinant tissue plasminogen activator (rt-PA) and stent retrieval are effective for treating acute ischemic stroke. The goal of this study was to evaluate the effectiveness of stent retrieval combined with intra-arterial rt-PA administration via micro-catheter (called the complex technique) in acute ischemic stroke.
A retrospective analysis was performed of 93 consecutive patients treated between 2015 and 2017 for occlusions of the intracranial large artery using the complex technique (n=37) or stent retrieval alone (n=56) in our stroke center. Data on procedure duration, number of passes, and angiographic findings were collected. Successful recanalization was defined as the accomplishment of grade 3 or 2b modified Treatment in Cerebral Ischemia recanalization in 1 or 2 passes.
Compared to the stent retrieval group, complex technique group had a higher successful revascularization rate with 1 or 2 passes with the stent retriever (81.1% versus 51.8%, P=0.004), a shorter procedure time (59±34min versus 94±56min, P<0.001), fewer passes of the stent retriever (1.8±1.1 versus 2.5±1.4, P=0.012), a better prognosis (70.3% versus 48.2%, P=0.035), a lower embolic complication rate (18.9% versus 39.3%, P=0.038), similar mortality (13.5% versus 21.4%, P=0.334) and similar intracranial hemorrhage symptoms (2.7% versus 12.5%, P=0.204). Intra-arterial rt-PA administration was an independent negative predictor of procedure time (OR=−0.292, P=0.003).
Mechanical thrombectomy utilizing stent retrieval combined with intra-arterial rt-PA administration in the anterior circulation of acute ischemic stroke patients improved the angiographic results and shortened the procedure duration without increasing adverse events.
•Stent retrieval combined with intra-arterial rt-PA administration (complex technique) shortened the procedure duration.•Complex technique decreases the likelihood of embolic event.•Complex technique increases the likelihood of good prognosis.</description><subject>Acute ischemic stroke</subject><subject>Aged</subject><subject>Brain Ischemia - complications</subject><subject>Cerebral Infarction - diagnostic imaging</subject><subject>Cerebral Infarction - etiology</subject><subject>Embolic event</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Humans</subject><subject>Injections, Intra-Arterial - methods</subject><subject>Intra-arterial thrombolysis</subject><subject>Magnetic Resonance Angiography</subject><subject>Male</subject><subject>Mechanical thrombectomy</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Statistics, Nonparametric</subject><subject>Stents</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - etiology</subject><subject>Stroke - therapy</subject><subject>Thrombectomy - methods</subject><subject>Tissue Plasminogen Activator - administration & dosage</subject><subject>Tomography Scanners, X-Ray Computed</subject><subject>Treatment Outcome</subject><issn>0022-510X</issn><issn>1878-5883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9q3DAQxkVpaLZpH6CXomMv3o6ktS3T0xL6DwLJoYXehFYesXJtayvJAT9LXraTbtpjYUBovm9-SPMx9kbAVoBo3g_bYc5bCUJvQVDJZ2wjdKurWmv1nG0ApKxqAT8u2cucBwBotO5esEvZ7aDpWtiwh30_LPd2LjzMJdnKpoIp2JGnUt3tqTmgKyHO3BZejkiNUEgeV97jaYwr9jzHMRQbEvJckEA4H-3sMP_xo_fBWbfy6PmEjhS6jiSlOB0IHaeVmNy6pRA8uyNOwREoxZ_4il14O2Z8_XRese-fPn67_lLd3H7-er2_qZyqVamUbrw8HFrlWq-8hl4oK7RrtVfSWQTQXtdWYmNr8tdS9Y3d9dAA1G3rvFBX7N2Ze0rx14K5mIleguNoZ4xLNqLrOtHpXavJKs5Wl2LOCb05pTDZtBoB5jETMxjKxDxmYkBQSZp5-4RfDhP2_yb-hkCGD2cD0ifvAyaTXUBaYU9LdcX0MfwH_xsVU6AG</recordid><startdate>20180315</startdate><enddate>20180315</enddate><creator>Yi, Ting-Yu</creator><creator>Chen, Wen-Huo</creator><creator>Wu, Yan-Min</creator><creator>Zhang, Mei-Fang</creator><creator>Lin, Ding-Lai</creator><creator>Lin, Xiao-Hui</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7031-8917</orcidid></search><sort><creationdate>20180315</creationdate><title>Adjuvant intra-arterial rt-PA injection at the initially deployed solitaire stent enhances the efficacy of mechanical thrombectomy in acute ischemic stroke</title><author>Yi, Ting-Yu ; Chen, Wen-Huo ; Wu, Yan-Min ; Zhang, Mei-Fang ; Lin, Ding-Lai ; Lin, Xiao-Hui</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-386f2bb73c7f3f80d13a18c78f32cae008f85a2e6a5353523d6a4d0600577cf13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute ischemic stroke</topic><topic>Aged</topic><topic>Brain Ischemia - complications</topic><topic>Cerebral Infarction - diagnostic imaging</topic><topic>Cerebral Infarction - etiology</topic><topic>Embolic event</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Humans</topic><topic>Injections, Intra-Arterial - methods</topic><topic>Intra-arterial thrombolysis</topic><topic>Magnetic Resonance Angiography</topic><topic>Male</topic><topic>Mechanical thrombectomy</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Statistics, Nonparametric</topic><topic>Stents</topic><topic>Stroke - diagnostic imaging</topic><topic>Stroke - etiology</topic><topic>Stroke - therapy</topic><topic>Thrombectomy - methods</topic><topic>Tissue Plasminogen Activator - administration & dosage</topic><topic>Tomography Scanners, X-Ray Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yi, Ting-Yu</creatorcontrib><creatorcontrib>Chen, Wen-Huo</creatorcontrib><creatorcontrib>Wu, Yan-Min</creatorcontrib><creatorcontrib>Zhang, Mei-Fang</creatorcontrib><creatorcontrib>Lin, Ding-Lai</creatorcontrib><creatorcontrib>Lin, Xiao-Hui</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the neurological sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yi, Ting-Yu</au><au>Chen, Wen-Huo</au><au>Wu, Yan-Min</au><au>Zhang, Mei-Fang</au><au>Lin, Ding-Lai</au><au>Lin, Xiao-Hui</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adjuvant intra-arterial rt-PA injection at the initially deployed solitaire stent enhances the efficacy of mechanical thrombectomy in acute ischemic stroke</atitle><jtitle>Journal of the neurological sciences</jtitle><addtitle>J Neurol Sci</addtitle><date>2018-03-15</date><risdate>2018</risdate><volume>386</volume><spage>69</spage><epage>73</epage><pages>69-73</pages><issn>0022-510X</issn><eissn>1878-5883</eissn><abstract>Both intra-arterial recombinant tissue plasminogen activator (rt-PA) and stent retrieval are effective for treating acute ischemic stroke. The goal of this study was to evaluate the effectiveness of stent retrieval combined with intra-arterial rt-PA administration via micro-catheter (called the complex technique) in acute ischemic stroke.
A retrospective analysis was performed of 93 consecutive patients treated between 2015 and 2017 for occlusions of the intracranial large artery using the complex technique (n=37) or stent retrieval alone (n=56) in our stroke center. Data on procedure duration, number of passes, and angiographic findings were collected. Successful recanalization was defined as the accomplishment of grade 3 or 2b modified Treatment in Cerebral Ischemia recanalization in 1 or 2 passes.
Compared to the stent retrieval group, complex technique group had a higher successful revascularization rate with 1 or 2 passes with the stent retriever (81.1% versus 51.8%, P=0.004), a shorter procedure time (59±34min versus 94±56min, P<0.001), fewer passes of the stent retriever (1.8±1.1 versus 2.5±1.4, P=0.012), a better prognosis (70.3% versus 48.2%, P=0.035), a lower embolic complication rate (18.9% versus 39.3%, P=0.038), similar mortality (13.5% versus 21.4%, P=0.334) and similar intracranial hemorrhage symptoms (2.7% versus 12.5%, P=0.204). Intra-arterial rt-PA administration was an independent negative predictor of procedure time (OR=−0.292, P=0.003).
Mechanical thrombectomy utilizing stent retrieval combined with intra-arterial rt-PA administration in the anterior circulation of acute ischemic stroke patients improved the angiographic results and shortened the procedure duration without increasing adverse events.
•Stent retrieval combined with intra-arterial rt-PA administration (complex technique) shortened the procedure duration.•Complex technique decreases the likelihood of embolic event.•Complex technique increases the likelihood of good prognosis.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>29406970</pmid><doi>10.1016/j.jns.2018.01.012</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-7031-8917</orcidid></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Acute ischemic stroke Aged Brain Ischemia - complications Cerebral Infarction - diagnostic imaging Cerebral Infarction - etiology Embolic event Female Fibrinolytic Agents - administration & dosage Humans Injections, Intra-Arterial - methods Intra-arterial thrombolysis Magnetic Resonance Angiography Male Mechanical thrombectomy Middle Aged Retrospective Studies Statistics, Nonparametric Stents Stroke - diagnostic imaging Stroke - etiology Stroke - therapy Thrombectomy - methods Tissue Plasminogen Activator - administration & dosage Tomography Scanners, X-Ray Computed Treatment Outcome |
| title | Adjuvant intra-arterial rt-PA injection at the initially deployed solitaire stent enhances the efficacy of mechanical thrombectomy in acute ischemic stroke |
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