Adjuvant intra-arterial rt-PA injection at the initially deployed solitaire stent enhances the efficacy of mechanical thrombectomy in acute ischemic stroke

J Neurol Sci. 2018 Mar 15;386:69-73. doi: 10.1016/j.jns.2018.01.012. Epub 2018 Jan 10.

Abstract

Background: 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.

Material and methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Acute ischemic stroke; Embolic event; Intra-arterial thrombolysis; Mechanical thrombectomy.

MeSH terms

  • Aged
  • Brain Ischemia / complications
  • Cerebral Infarction / diagnostic imaging
  • Cerebral Infarction / etiology
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Humans
  • Injections, Intra-Arterial / methods
  • Magnetic Resonance Angiography
  • Male
  • 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

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator