Analysis of the safety and efficacy of intra-arterial thrombolytic therapy in ischemic stroke

被引:100
作者
Lisboa, RC
Jovanovic, BD
Alberts, MJ
机构
[1] Northwestern Univ, Sch Med, Dept Neurol, Chicago, IL 60611 USA
[2] Northwestern Univ, Sch Med, Dept Prevent Med, Chicago, IL 60611 USA
关键词
stroke; ischemic; thrombolytic therapy;
D O I
10.1161/01.STR.0000038987.62325.14
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Intra-arterial thrombolytic therapy (IAT) may be a treatment option for patients with ischemic stroke. We analyzed the safety and efficacy of IAT on the basis of published data. Methods-We searched computerized databases for studies using IAT in greater than or equal to10 patients with ischemic stroke. Some studies had control patients for comparison. Data were collected on age, stroke territory, time to treatment, medication, site of arterial occlusion and recanalization on angiogram, outcomes, and symptomatic intracranial hemorrhage (SICH). Results-The analysis included 27 studies with 852 patients who received IAT and 100 control subjects. There were more favorable outcomes in the IAT than in the control group (41.5% versus 23%, P=0.002), with a lower mortality rate for IAT (IAT, 27.2%; control group, 40%, P=0.004). The IAT group had an odds ratio of 2.4 (95% CI, 1.45 to 3.85) for favorable outcome. SICH was more frequent in the IAT group compared with the control group (9.5% versus 3%, P=0.046). The subgroup of patients receiving a combination of intravenous thrombolytic therapy and IAT had more favorable outcomes than the IAT alone subgroup, but this trend did not reach statistical significance (53.6% versus 41.5%, P=0.1). Among the patients treated with IAT, those who had supratentorial strokes were more likely to have favorable outcomes than those with infratentorial strokes (42.2% versus 25.6%; P=0.001; odds ratio, 2.0; 95% CI, 1.33 to 3.0). Conclusions-IAT for ischemic stroke appears efficacious but carries an increased risk of SICH. Further prospective studies are needed to prove the safety and efficacy of IAT in stroke.
引用
收藏
页码:2866 / 2871
页数:6
相关论文
共 53 条
[1]   Intravenous tissue-type plasminogen activator for treatment of acute stroke - The standard treatment with alteplase to reverse stroke (STARS) study [J].
Albers, GW ;
Bates, VE ;
Clark, WM ;
Bell, R ;
Verro, P ;
Hamilton, SA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 283 (09) :1145-1150
[2]  
*AM HEART ASS, 2000, 19999 HEART STROK ST
[3]   BASILAR ARTERY-OCCLUSION - CLINICAL AND RADIOLOGICAL CORRELATION [J].
ARCHER, CR ;
HORENSTEIN, S .
STROKE, 1977, 8 (03) :383-390
[4]   ACUTE STROKE INTERVENTION WITH INTRAARTERIAL UROKINASE INFUSION [J].
BARR, JD ;
MATHIS, JM ;
WILDENHAIN, SL ;
WECHSLER, L ;
JUNGREIS, CA ;
HORTON, JA .
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 1994, 5 (05) :705-713
[5]  
Becker KJ, 1996, AM J NEURORADIOL, V17, P255
[6]   Outcome after local intra-arterial fibrinolysis compared with the natural course of patients with a dense middle cerebral artery on early CT [J].
Bendszus, M ;
Urbach, H ;
Ries, F ;
Solymosi, L .
NEURORADIOLOGY, 1998, 40 (01) :54-58
[7]  
BOCKENHEIMER S, 1991, RADIOLOGE, V31, P210
[8]  
BRODERICK JP, 2002, 27 INT STROK C FEBR
[9]  
Bruckmann H, 1986, Acta Radiol Suppl, V369, P38
[10]   BILATERAL DISTAL VERTEBRAL ARTERY-OCCLUSION [J].
CAPLAN, LR .
NEUROLOGY, 1983, 33 (05) :552-558