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Intra-Arterial vs Intra-Venous Thrombolysis for Anterior Cerebral Occlusion

Published online by Cambridge University Press:  02 December 2014

Bin Zhang ,
Xiaojiang Sun ,
Minghua Li ,
Feng Wang ,
Dan Xu ,
Hao Duan  and
Chun Fang
Bin Zhang
Affiliation:
Department of Neurology and Neurobiology Laboratory
Xiaojiang Sun*
Affiliation:
Department of Neurology and Neurobiology Laboratory
Minghua Li
Affiliation:
Department of Radiology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
Feng Wang
Affiliation:
Department of Neurology and Neurobiology Laboratory
Dan Xu
Affiliation:
Department of Neurology and Neurobiology Laboratory
Hao Duan
Affiliation:
Department of Neurology and Neurobiology Laboratory
Chun Fang
Affiliation:
Department of Radiology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
*
Department of Neurology and Neurobiology Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, No 600, Yishan Road, Shanghai 200233, China.
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Abstract

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Background:

The safety and effectiveness of intra-arterial thrombolysis (IAT) in comparison to intravenous thrombolysis (IVT) for the treatment of ischemic stroke is uncertain. Our study aims to assess and compare IAT to IVT for clinically relevant outcomes in patients with occlusion of the anterior cerebral circulation.

Methods:

Patients with acute ischemic stroke were enrolled for either treatment; those whose symptoms occurred within 4.5 hrs after stroke were treated with IVT, whereas those who presented <4.5 hrs but had contraindications to IVT or presented between 4.5 and 6 hrs were treated with IAT. Evaluated endpoints included: disability at 90 days as measured by the modified Rankin Scale (mRS), incidence of mortality, and incidence of symptomatic intracranial haemorrhage.

Results:

78 patients with anterior cerebral circulation occlusion were included in the study (55 in IVT, 23 in IAT). After 90 days, 82.6% patients treated with IAT reached independence in comparison to 56.4% in the IVT group (P=0.028, RR=2.66, 95% CI: 1.10-7.04). The incidence of all intracranial haemorrhages in the IAT and IVT groups respectively were 30.4% and 12.7% (P=0.103, RR=2.391, 95% CI: 0.946-6.047); symptomatic intracranial haemorrhage occurred in 8.7% and 9.1% of patients (P=1.00, RR= 0.957, 95% CI: 0.200-4.579), and mortality in 8.7% and 16.4% (P=0.492, RR=1.882, 95% CI: 0.440-8.045).

Conclusion:

Results suggest that IAT is more effective than IVT in allowing patients to achieve independence. While inconclusive, the safety of IAT within 6 hrs is comparable to IVT within 4.5 hrs.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 2 , March 2010 , pp. 240 - 244
Copyright
Copyright © The Canadian Journal of Neurological 2010

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