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Combined intravenous and intraarterial revascularization therapy using MRI perfusion/diffusion mismatch selection for acute ischemic stroke at 3-6 h after symptom onset

Cited 12 time in Web of Science Cited 11 time in Scopus
Authors
Han, Moon-Ku; Kim, Sung Hyun; Ko, Sang-Bae; Paik, Nam-Jong; Kwon, O-Ki; Lee, Yong-Seok; Oh, Chang-Wan; Kim, Jae Hyoung; Park, Seong-Ho; Bae, Hee-Joon
Issue Date
2008-03-15
Publisher
Humana Press (Springer Imprint)
Citation
Neurocrit Care. 2008;8(3):353-359
Keywords
Acute DiseaseAdultAgedBrain Ischemia/*drug therapy/*pathology/radiographyCerebral AngiographyCerebral Revascularization*Diffusion Magnetic Resonance ImagingDrug Therapy, CombinationFeasibility StudiesFemaleFibrinolytic Agents/administration & dosageHumansInjections, Intra-ArterialInjections, IntravenousMaleMiddle AgedProspective StudiesStroke/*drug therapy/*pathology/radiographyThrombolytic Therapy/*methodsTissue Plasminogen Activator/administration & dosageTreatment OutcomeUrokinase-Type Plasminogen Activator/administration & dosage
Abstract
BACKGROUND AND PURPOSE: Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) has demonstrated favorable clinical outcomes in a 3-6 h window in patients selected with perfusion/diffusion mismatch. However, the advantages of combined IV and intraarterial (IA) thrombolysis after 3 h of stroke onset are unexplored. METHODS: Acute ischemic stroke patients with persistent occlusion of intracranial large arteries were screened prospectively for thrombolysis by evaluating perfusion/diffusion mismatch on MRI. The IV rt-PA was initiated within 3-6 h, and additional urokinase (UK) was then administered via the IA route after angiography. RESULTS: Four patients had middle cerebral artery occlusion and one patient had an internal carotid artery occlusion. The median time from the symptom onset to the initiation of IV therapy and to the initiation of IA treatment was 215 +/- 30 min and 292 +/- 41 min, respectively. The median National Institutes of Health Stroke Scale (NIHSS) scores were as follows: initial, 13; immediately after IA treatment, 8; at 24 h, 5; and at 7 days, 3. The Thrombolysis in Myocardial Infarction (TIMI) score after the completion of thrombolysis was 2-3. Four patients without intracerebral hemorrhage recovered completely or exhibited mild disability and one patient with hemorrhage also demonstrated a favorable outcome. CONCLUSION: This preliminary result suggests that if a significant perfusion/diffusion mismatch on MRI is identified, a sequential combination thrombolysis of IV rt-PA and IA UK is potentially beneficial in moderate to severe acute ischemic stroke patients who are treated within 3-6 h after symptom onset.
ISSN
1541-6933 (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18340411

http://www.springerlink.com/content/bk96g30611v85w60/fulltext.pdf

http://hdl.handle.net/10371/68160
DOI
https://doi.org/10.1007/s12028-007-9046-7
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Neurology (신경과학교실)Journal Papers (저널논문_신경과학교실)
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