Intra-Arterial Therapy as a Rescue Strategy after Clinically Failed Intravenous Thrombolysis May Increase the Likelihood of a Good Outcome in Patients with Severe Ischaemic Stroke A Retrospective Two Centre Study

• Published in: Interventional neuroradiology Vol. 20; no. 3; pp. 329 - 335
• Main Authors: Menetti, Federico, Verganti, Luca, Zini, Andrea, Vallone, Stefano, Carpeggiani, Paolo, Andersson, Tommy
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2014; Centauro S.r.l
• Subjects: Adolescent; Adult; Aged; Brain Ischemia - complications; Brain Ischemia - diagnostic imaging; Brain Ischemia - therapy; Cerebral Arteries - surgery; Cerebral Revascularization - methods; Female; Fibrinolytic Agents - administration & dosage; Humans; Italy; Male; Medicin och hälsovetenskap; Middle Aged; Original; Radiography; Reoperation - methods; Retrospective Studies; Stroke - diagnostic imaging; Stroke - etiology; Stroke - therapy; Sweden; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; Treatment Failure; Treatment Outcome; Young Adult; intravenous thrombolysis; intra-arterial treatment; rescue therapy; acute ischaemic stroke
• ISSN: 1591-0199; 2385-2011; 1591-0199
• DOI: 10.15274/INR-2014-10030

The purpose of this study was to evaluate the efficacy and safety of intra-arterial therapy as a rescue strategy after clinically failed intravenous thrombolysis (IVT) in acute ischaemic stroke patients. We conducted a retrospective analysis of consecutive acute ischaemic stroke patients treated with rescue therapy. The results from this study group were compared with those obtained from a control group consisting of 260 consecutive patients treated with IVT alone. The study group consisted of 52 patients with a mean age of 63 years and a median NIHSS score at admission of 17. Recanalization was achieved in 92% with a symptomatic haemorrhage rate of 9.6%. Rescue patients admitted with a severe stroke (NIHSS score >12) had a significantly better outcome at 90 days compared to patients with the same score but treated with IVT alone. No difference was seen for patients with a lower score at admission. This study indicates that rescue therapy may increase the proportion of patients with independent outcome if presenting with a severe stroke (NIHSS score >12) without increasing the rate of symptomatic haemorrhage.