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Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke
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Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke
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Journal Article
Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke
2015
Overview
In acute ischemic stroke, thrombectomy with a stent retriever plus intravenous t-PA was more effective than t-PA in improving functional outcomes. At 90 days, 60% of patients in the intervention group were functionally independent, as compared with 35% in the control group.
Intravenous tissue plasminogen activator (t-PA) administered within 4.5 hours after the onset of acute ischemic stroke improves outcomes.
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However, intravenous t-PA has multiple constraints, including unresponsiveness of large thrombi to rapid enzymatic digestion, a narrow time window for administration, and the risk of cerebral and systemic hemorrhage. Among patients with occlusions of the intracranial internal carotid artery or the first segment of the middle cerebral artery (or both), intravenous t-PA results in early reperfusion in only 13 to 50%.
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Neurovascular thrombectomy is a reperfusion strategy that is distinct from pharmacologic fibrinolysis. Endovascular mechanical treatments can remove large, proximal . . .
Publisher
Massachusetts Medical Society
Subject
/ Aged
/ Cardiology and cardiovascular system
/ Female
/ Fibrinolytic Agents - adverse effects
/ Fibrinolytic Agents - therapeutic use
/ Humans
/ Implants
/ Ischemia
/ Male
/ Stents
/ Stroke
/ Thrombectomy - adverse effects
/ Thrombectomy - instrumentation
/ Tissue Plasminogen Activator - adverse effects
