Early outcome of combined thrombolysis based on the mismatch on perfusion CT

Cerebrovasc Dis. 2009;28(3):259-65. doi: 10.1159/000228256. Epub 2009 Jul 15.


Background: Possible factors associated with early outcome after thrombolysis are the recanalization time and the status of tissue. We assessed whether combined intravenous (IV) and intra-arterial (IA) thrombolysis performed according to the status of tissue based on perfusion computed tomography (PCT) is beneficial for the early outcome in patients with acute ischemic stroke.

Methods: To improve the recanalization time, we assumed that combined IA thrombolysis after IV thrombolysis would be beneficial. Eligible patients for combined thrombolysis were selected according to the status of tissue based on PCT. Recanalization was defined as Thrombolysis in Myocardial Infarction (TIMI) grade 2 or 3. 'Good functional outcome' was defined as a Modified Rankin Scale (mRS) score of 2 or less at discharge.

Results: Eighteen patients (11 men) underwent combined IV/IA thrombolysis. The recanalization rate after combined IV/IA thrombolysis was 88.9% (TIMI 2, 4; TIMI 3, 12). A good functional outcome at discharge was noted in 12 patients (66.7%). The incidence of symptomatic intracranial hemorrhage was 5.6% (1/18).

Conclusions: The results of this study suggest that combined IV/IA thrombolysis based on the presence of mismatches on PCT might have a relatively high rate of recanalization and a favorable early outcome. In addition, the incidence of symptomatic intracranial hemorrhage was acceptable.

MeSH terms

  • Aged
  • Brain Ischemia / complications
  • Brain Ischemia / diagnostic imaging
  • Cerebral Angiography
  • Cerebrovascular Circulation / physiology
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Intracranial Hemorrhages / complications
  • Intracranial Hemorrhages / diagnostic imaging
  • Male
  • Middle Aged
  • Perfusion
  • Stroke / diagnostic imaging*
  • Stroke / therapy*
  • Thrombolytic Therapy*
  • Tissue Plasminogen Activator / therapeutic use
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator