Skip Navigation LinksHome > January 2005 - Volume 56 - Issue 1 > Intra-arterial Thrombolysis for Acute Ischemic Stroke: Preli...
Neurosurgery:
doi: 10.1227/01.NEU.0000145785.69942.B3
Clinical Studies: CEREBROVASCULAR

Intra-arterial Thrombolysis for Acute Ischemic Stroke: Preliminary Experience with Platelet Glycoprotein IIb/IIIa Inhibitors as Adjunctive Therapy

Deshmukh, Vivek R. M.D.; Fiorella, David J. M.D.; Albuquerque, Felipe C. M.D.; Frey, James M.D.; Flaster, Murray M.D.; Wallace, Robert C. M.D.; Spetzler, Robert F. M.D.; McDougall, Cameron G. M.D.

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Abstract

OBJECTIVE: To evaluate the safety profile of platelet glycoprotein IIb/IIIa inhibitors administered as adjunctive therapy to patients with large-vessel occlusion and acute ischemic stroke refractory to pharmacological thrombolysis with recombinant tissue plasminogen activator (rtPA) and mechanical disruption, balloon angioplasty, or both.

METHODS: Twenty-one patients (mean age, 62 yr; range, 29–88 yr) met the following criteria: 1) large-vessel occlusion and acute ischemic stroke syndrome at presentation, 2) failure to recanalize after administration of rtPA (intra-arterial and/or intravenous) with or without mechanical thrombolysis, and 3) subsequent treatment with IIb/IIIa inhibitors (intra-arterial or intravenous).

RESULTS: Eleven patients had ischemia in the dominant hemisphere, 8 in the vertebrobasilar system, and 2 in the nondominant hemisphere. Twelve patients received intravenous rtPA without significant improvement; 9 patients were not candidates for intravenous rtPA. All patients received intra-arterial rtPA. The IIb/IIIa inhibitors were administered intravenously in 3 patients, intra-arterially in 16, and both intravenously and intra-arterially in 2. Balloon angioplasty was performed in 18 patients. Complete or partial recanalization was achieved in 17 of the 21 patients. After thrombolysis, 15 improved clinically. Three patients (14%) sustained an asymptomatic intracerebral hemorrhage after thrombolytic therapy. No patient was clinically worse after intervention. At last follow-up (mean, 8.5 mo), 13 patients were functionally independent (modified Rankin score, 0–3) and 8 were disabled or dead.

CONCLUSION: IIb/IIIa inhibitors are an alternative for achieving recanalization. The risk of hemorrhage may be low. As part of an escalating protocol that includes pharmacological and mechanical thrombolysis, IIb/IIIa inhibitors may improve clinical outcomes.

Copyright © by the Congress of Neurological Surgeons

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