Acute intravenous--intra-arterial revascularization therapy for severe ischemic stroke.

Hill, MD; Barber, P; Demchuk, A; Newcommon, N; Cole-Haskayne, A; Ryckborst, K; Sopher, L; Button, A; Hu, W; Hudon, M; Morrish, W; Frayne, R; Sevick, R; Buchan, A

Neuroscience & Neuroimaging Research Collection

Journal article

Acute intravenous--intra-arterial revascularization therapy for severe ischemic stroke.

Abstract:: BACKGROUND: Intravenous alteplase for acute ischemic stroke is least efficacious for patients with proximal large-artery occlusions and clinically severe strokes. Intra-arterial therapy has the theoretical advantage of establishing a neurovascular diagnosis and high symptomatic artery patency rate but the disadvantage of requiring extra time and technical expertise. A combination of these two approaches may provide the best chance of improving outcome in severe acute ischemic stroke. We sought to assess the safety and feasibility of this approach. METHODS: This was a prospective, open-label study. Sequential patients arriving to our center within 3 hours of stroke onset who were treated with intravenous alteplase were screened for possible additional intra-arterial therapy using noninvasive neuroimaging. Clinical measures and outcomes were recorded prospectively. RESULTS: A total of 861 patients with ischemic stroke were admitted to Calgary hospitals during the study period. Eight patients over 21 months underwent a combined intravenous-intra-arterial approach. Six received intra-arterial alteplase and 1 underwent intracranial angioplasty; in a final patient, technical aspects prevented intra-arterial therapy. Early neurovascular and/or neurometabolic imaging identified the location of occlusion and tissue-at-risk (DWI-PWI mismatch) in all 8 patients. Two patients had a poor outcome, 1 patient suffered a significant groin hematoma, and there were no instances of symptomatic intracerebral hemorrhage. CONCLUSIONS: Intravenous followed by intra-arterial therapy is a promising approach to the treatment of severe acute ischemic stroke. Early noninvasive neurovascular and neurometabolic imaging is very helpful in choosing candidates for this type of therapy. On-going monitoring of alteplase-treated patients may allow the opportunity to perform rescue intra-arterial therapy.

Publication status:: Published

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APA Style

Hill, M. D., Barber, P., Demchuk, A., Newcommon, N., Cole-Haskayne, A., Ryckborst, K., Sopher, L., Button, A., Hu, W., Hudon, M., Morrish, W., Frayne, R., Sevick, R., & Buchan, A. (2002). Acute intravenous--intra-arterial revascularization therapy for severe ischemic stroke. Stroke; a Journal of Cerebral Circulation, 33(1), 279–282.

MLA Style

Hill, MD, et al. “Acute Intravenous--Intra-Arterial Revascularization Therapy for Severe Ischemic Stroke.” Stroke; a Journal of Cerebral Circulation, vol. 33, no. 1, 2002, pp. 279–82.

Chicago Style

Hill, MD, P Barber, A Demchuk, et al. 2002. “Acute Intravenous--Intra-Arterial Revascularization Therapy for Severe Ischemic Stroke.” Stroke; a Journal of Cerebral Circulation 33 (1): 279–82.
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