Subsequently, multiple anecdotal reports and small nonrandomized or controlled series have also supported that intraarterial thrombolytic therapy may be useful for treatment of acute. Angiographically documented hemorrhagic conversion of a. To show that this procedure can be performed in community hospitals, we describe our experience with a group of 11 patients treated for middle. Intraarterial stroke management pubmed central pmc. Thirteen patients with acute ischemic stroke within 12 days of cardiac operation underwent. In ia thrombolysis, the cervicocephalic arterial tree is traversed with an endovascular microcatheter delivery system, the catheter port is positioned immediately within and adjacent to the offending thrombus, and fibrinolytic agents are infused directly into the clot. The aspects scoring system is simple and may be able to predict the outcome after intravenous thrombolytic therapy. Previous article intra arterial thrombolysis for hyperacute stroke next article pumpless extracorporeal lung assist sirhiroshi nawashiro and shinji fukui raise several important issues about why some stroke patients respond to thrombolytic therapy and others do not, some of whom seem to be harmed by it. Intra arterial thrombo lys is randomized controlled. Intra arterial ia thrombolysis provides an alternative to intravenous iv thrombolysis in selected patients with acute ischemic stroke. Intraarterial prourokinase for acute ischemic stroke. Intraarterial versus systemic thrombolysis for acute. Intra arterial therapy in acute ischemic stroke dr.
Intra arterial thrombolysis for symptom onset within 6 hours. Intra arterial thrombolysis, administered within six hours of symptoms onset, has been shown in a randomized, prospective, multicenter trial and in several nonrandomized case series to be beneficial in acute ischemic stroke caused by occlusion of the middle cerebral artery or its major divisions. Intraarterial administration of recombinant tissuetype. Endovascular thrombectomy for large vessel ischaemic stroke substantially reduces disability, with recent positive randomised trials leading to guideline changes worldwide. Safety of intraarterial thrombolysis in the postoperative. Ischaemic stroke osama ragab lecturer of neurology tanta university 2016 2.
Antithrombotic and thrombolytic therapy for ischemic stroke. Intraarterial thrombolysis for acute stroke in patients 80 and older. Cerebral stroke, intra arterial thrombolysis treatment, ct perfusion imaging. Combined intravenous and intra arterial rtpa versus intra arterial therapy for acute stroke. A traditional recanalization approach based on historical controls and pathophysiological consideration is local intra arterial thrombolysis iat in eligible patients. Endovascular therapy for ischemic stroke with perfusion. Intraarterial ia thrombolysis is an emerging treatment strategy for acute ischemic stroke. Iat techniques included thrombectomy n19, ia thrombolysis n17, stenting n14, and angioplasty n7. Ischemic stroke is a major public health problem worldwide. Intravenous versus intraarterial thrombolysis in ischemic. Intra arterial thrombo lys is free download as powerpoint presentation.
Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Acute stroke practice guidelines for inpatient management. Pdf intraarterial thrombolysis in acute ischemic stroke. The potential to cure stroke patients with intravenous thrombolytic therapy has evolved to the use of intra arterial thrombolytic agents. Limited systemic fibrinolysis and reduced dosage are features of intra arterial thrombolyis iat that may be advantageous in the treatment of postoperative strokes. In the extending the time for thrombolysis in emergency neurological deficits intra arterial extendia trial, we sought to test the hypothesis that patients with anterior circulation. Accepted november 14 2014 introduction cerebral stroke is a. Acute ischemic stroke after cardiac operations is a devastating complication with limited therapeutic options. Logistic regression models allow for the identification and validation of predictive variables. The role of recombinant prourokinase rprouk and intra.
The results of the melt trial, reported in this issue of stroke, are therefore very welcome, providing additional information regarding intra arterial fibrinolytic therapy that complements and supports previous studies. Acute stroke practice guidelines for inpatient management of ischemic stroke and transient ischemic attack tia, ps 01. Endovascular treatment of acute ischemic stroke with aid. However, advanced machine learning algorithms offer an alternative, in. Intraarterial thrombolysis in acute ischemic stroke. Emerging therapies intraarterial thrombolysis, angioplasty, and. Intraarterial thrombolysis for perioperative stroke after. Machine learning for outcome prediction of acute ischemic. Background and purpose basilar artery occlusion bao is an infrequent form of acute stroke, which invariably leads to death or longterm disability if not recanalized. The clinical efficacy and safety of ia thrombolysis with the selective thrombolytic rprourokinase rprouk has been demonstrated in two randomized acute stroke. Intraarterial versus systemic thrombolysis for acute ischemic stroke synthesis exp the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
If so, share your ppt presentation slides online with. Intraarterial therapy iat for acute ischemic stroke refers to endovascular catheterbased approaches to achieve recanalization using mechanical clot disruption, locally injected thrombolytic agents or both. Intra arterial thrombolysis for acute stroke ppt download. Intraarterial thrombolysis for acute ischemic stroke. Intraarterial cerebral fibrinolytic therapy for acute stroke was first described in 1983 by zeumer et al 11.
However, iat may increase the risk of surgical bleeding. A modified rankin score of 2 or less has been used as an indicator of functional independence in other thrombolysis stroke trials. Proact prolyse in acute cerebral thromboembolism trial was the first prospective randomized controlled trial rct to investigate the safety and efficacy of intra arterial recombinant prourokinase iaprouk and heparin compared with intra arterial heparin alone, applied within 6 h of stroke symptom onset in patients with middle cerebral artery occlusion. Introduction stroke is a major cause of death and disability. Use of salvage technical adjuncts including intra arterial thrombolysis may be reasonable to achieve mtici 2b3 angiographic result. The total dose of intra arterial therapy is about onethird of the intravenous dose.
As clinical trials of thrombolysis for acute ischemic stroke exclude patients with recent major surgery, the safety of intraarterial thrombolysis in this setting is unknown. Intra arterial thrombolysis may be an option for patients with cerebral embolism in the perioperative period. Intraarterial thrombolysis should be given in stroke centres with the appropriate level of experience in patients who fulfil the criteria for iv. Intravenous tissue plasminogen activator tpa is the only approved. If a patient has had thrombolysis before, an allergy against the thrombolytic drug. Intraarterial therapy for acute ischemic stroke ncbi. Recent advances in the field of neurointerventional radional. Six patients with acute ischemic stroke underwent intra arterial thrombolysis after recent open heart surgery without clinically significant bleeding complications, although one patient developed a small, asymptomatic cerebellar hemorrhage. Comprehensive analysis of intraarterial treatment for. Local intraarterial fibrinolytic therapy in patients with stroke. Listing a study does not mean it has been evaluated by the u. On the other hand, thrombolytic infusion was the first and, for more than 15 years, the only intra arterial stroke treatment modality shown to provide any benefit to the patient population with lvo.
With the advancement in the thrombolytic treatment window of use that has reached 6 hours, the high safety profile of the treatment alternatives and the improvement in the thrombolysis techniques i. Introduction acute ischemic stroke ais is the leading cause of adult disability and the third leading cause of death in the united states, yet until recently it was considered to be untreatable. Summary of case a case of angiographically documented hemorrhagic conversion of an ischemic stroke during intra arterial thrombolysis is presented. Intraarterial fibrinolysis for acute ischemic stroke stroke. Background reperfusion following ischemic stroke can be attained by either intravenous thrombolysis ivt or intra arterial thrombolysis iat. Advances in thrombolytic therapy, brain imaging, and neurointerventional techniques provide new therapeutic options for acute stroke. Intraarterial thrombolysis intra arterial thrombolysis should be given in stroke centres with the appropriate level of experience in patients who fulfil the criteria.
Intraarterial thrombolysis and thrombectomy for acute ischemic stroke. Stroke thrombolysis is considered to be one of the most beneficial stroke management techniques. Hemorrhagic stroke is a rare but serious complication of thrombolytic therapy. Intra arterial thrombolytic therapy can be very useful for the management of acute and chronic limb ischaemia, but complications do occur and patients should be carefully selected.
Although intravenous iv thrombolysis with tissue plasminogen activator tpa has. We sought to determine the safety of postoperative iat. This metaanalysis investigated possible clinical benefits of iat relative to ivt in patients with acute ischemic stroke. The proact ii trial randomised 180 patients with acute ischaemic stroke due to proven occlusion of the middle cerebral artery and without haemorrhage or major early infarction signs on ct scan to heparin and intra arterial prourokinase or heparin alone. Clinical outcome was measured by means of the modified rankin scale score and recanalization with the thrombolysis in cerebral infarction scale. At present, use of intra arterial thrombolytic therapy for ischemic stroke is investigational and should be confined to clinical trials or highly selected patients. Intravenous versus intraarterial thrombolysis in ischemic stroke.
Intra arterial thrombolysis for acute stroke is the property of its rightful owner. Acute stroke intervention american heart association. Intra arterial thrombolysis poses other unique stroke trial design issues. Recent advances in the field of neurointerventional. Intraarterial therapy iat for acute ischemic stroke refers to. Potential of intraarterial urokinase after incomplete.
Selection of acute ischemic stroke patients for intraarterial thrombolysis with prourokinase by using aspects. Intra arterial thrombolysis should only be administered by physicians with expertise in stroke and neurointerventional techniques. A free powerpoint ppt presentation displayed as a flash slide show on id. Selection of acute ischemic stroke patients for intraarterial. Intraarterial thrombolysis for hyperacute stroke the lancet. By delivering a higher concentration of drug directly into a clot, intra arterial ia thrombolysis may be more effective than intravenous therapy at opening a blocked artery. Thrombolysis, also known as thrombolytic therapy, is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs.
Ppt intraarterial thrombolysis powerpoint presentation. Only a limited number of randomized prospective studies have compared the efficacy and safety of ivt and iat. Intraarterial therapy iat for acute ischemic stroke treatment is evolving. Intra arterial ia administration of rtpa for ischemic stroke has the potential for greater thrombolytic efficacy, especially for a large thrombus in the m1 or m2 segment of the middle cerebral artery mca. Evolution of intraarterial therapy for acute ischemic. Intraarterial thrombolysis has proved to be a potent therapeutic tool.
The most common complication was haematoma at the site of cannulation of the vessel. Intraarterial thrombolysis and thrombectomy for acute. Endovascular treatment of acute ischemic stroke with aid of mechanical thrombectomy and intraarterial thrombolysis poster no c1036 congress. This article provides a brief overview of acute ischemic stroke, a summary of the major intra arterial stroke therapy trials, and comments on current training requirements for the performance of intra arterial therapies.
To predict the increased risk of symptomatic haemorrhagic transformation after intra arterial fibrinolysis, other methods such as local cerebral blood flow studies and diffusionweighted magnetic resonance imaging, might be needed. Previous article intra arterial thrombolysis for hyperacute stroke next article pumpless extracorporeal lung assist sirhiroshi nawashiro and shinji fukui raise several important issues about why some stroke patients respond to thrombolytic therapy. Intraarterial cerebral thrombolysis for acute ischemic. Intracranial hemorrhage ich is a concern with ia or intravenous iv administration especially as the therapeutic window is extended. Safety and efficacy of intraarterial thrombolysis for. Discussion focuses on recognition and management of risk factors for. Intraarterial thrombolysis in stroke linkedin slideshare. Intra arterial thrombolysis treated patients with acute ischemic stroke due to cervical artery dissection the majority of patients had multiple iat techniques, with a median of 2 23 techniques.
At present, for thrombolysis in ischemic stroke only intravenous alteplase is licensed in most countries, whereas urokinase, prourokinase, and desmoteplase are investigational. Intra arterial thrombolysis for moderate or severe stroke up to 6 hours ott may be justified as offlabel treatment in specialized centers but is generally unapproved. Intraarterial thrombolytic therapy in the management of. Taking advantage of the delay until october 2005 of regulatory approval in japan of intravenous tissue plasminogen activator. Background and purpose the clinical benefits of intra arterial thrombolysis for ischemic stroke must be weighed against the risks, including hemorrhagic conversion.214 570 1506 168 804 268 1502 679 541 428 996 502 650 493 199 807 253 362 806 448 81 167 501 740 1130 1109 60 1304 1381 1427 4 379 716 583 532 298 1340 1390 16 321 574 187 608 328 464