Key result
Local intraarterial rtPA thrombolysis within 6 hours of acute MCA infarction achieved a 75% recanalization rate compared to 12.5% with intravenous heparin, significantly improving 90-day outcomes.
Why the study?
Does local intraarterial thrombolysis with rtPA improve clinical outcomes in patients with acute middle cerebral artery infarctions within 6 hours of onset compared to intravenous heparin?
Cohort (n=32)
Does local intraarterial thrombolysis with rtPA improve clinical outcomes in patients with acute middle cerebral artery infarctions within 6 hours of onset compared to intravenous heparin?
Local intraarterial rtPA within 6 hours of acute MCA infarction improves 90-day clinical outcomes and recanalization rates compared to intravenous heparin.
Should not yet change practice for acute MCA infarction; leaves open randomized confirmation of benefit versus heparin.
BACKGROUND: Cerebral infarction is usually due to arterial occlusion. Prompt treatment with thrombolytic drugs can restore blood flow and improve recovery from an infarct. PURPOSE: To evaluate the clinical efficacy and safety of local intraarterial thrombolysis with recombinant tissue-type plasminogen activator (rtPA) in patients with acute middle cerebral artery (MCA) infarctions within 6 hours of the onset of symptoms. MATERIAL AND METHODS: Sixteen patients (10 females and six males) aged from 42 to 61 years, with acute MCA territory infarcts were selected for treatment with local i.a. rtPA up to 6 hours after the onset of symptoms. Patient selection was based on clinical examination, computed tomography (CT), and digital subtraction angiography (DSA). A clinical evaluation was performed before treatment, at the time of discharge, and 90 days post-procedure on the basis of modified Rankin and NIHSS scores. Controls (n = 16, nine females and seven males) aged from 51 to 70 years were treated only with intravenous anticoagulation using i.v. heparin infusion. The control group was evaluated with multidetector CT (MDCT) angiography performed on entry to the study and at 2-4 hours afterwards. RESULTS: Eight patients (50%) achieved a modified Rankin score of 2 or less as the primary outcome after 90 days follow-up. The secondary clinical outcome at 90-day follow-up was as follows: NIHSS score < or =1, three (19%) of the patients; NIHSS score > or =50% decrease, nine (56%) of the patients. A recanalization rate of 75% was achieved in 12 of the 16 treated patients, but only 12.5% in two of the 16 patients in the control group. Intracerebral hemorrhage occurred in two (12.5%) of the patients in the treatment group, but in only one patient (6%) in the control group. There were no deaths in the treated group after thrombolysis up to the time of discharge; however, during the 90-day follow-up, two patients died compared to three patients in the control group (19% vs. 12.5% mortality rate). CONCLUSION: Patients with cerebral infarction who were treated within 6 hours of onset using intraarterial rtPA thrombolysis had a significantly improved clinical outcome 90 days after the procedure compared to patients treated only with intravenous anticoagulation.
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Poncyljusz et al. (2007) conducted a cohort in acute middle cerebral artery (MCA) infarctions (n=32). local intraarterial thrombolysis with recombinant tissue-type plasminogen activator (rtPA) vs. intravenous anticoagulation using i.v. heparin infusion was evaluated on modified Rankin score of 2 or less at 90 days. Local intraarterial rtPA thrombolysis within 6 hours of acute MCA infarction achieved a 75% recanalization rate compared to 12.5% with intravenous heparin, significantly improving 90-day outcomes.
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