UMEM Educational Pearls

Category: Neurology

Title: Intra-arterial (IA) Thrombolysis

Keywords: Ischemic Stroke, Intra-arterial Thrombolysis, IA tPA, Intra-venous Thrombolysis, IV tPA (PubMed Search)

Posted: 12/13/2007 by Aisha Liferidge, MD (Updated: 7/10/2020)
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  • IA lytics for stroke emerged to increase the 3-hour window for treatment.
  • IA tPA may also be indicated for:

              --  candidates with severe neurological deficits (NIHSS score > 10)

              --  candidates with a recent history of major surgical procedures

              --  candidates with occlusion of major cervical or intracranial vessels

  • Early IA lytic trials utilized urokinase and tPA, usually within a 6-hour window, though some reports extended the window to 12 hours for posterior circulation ischemic strokes.
  • Studies have shown that THERE IS NO SIGNIFICANT DIFFERENCE IN RECANALIZATION RATE, SYMPTOMATIC HEMORRHAGE, AND NIHSS FOR IV PLUS IA LYSIS VERSUS IA LYSIS ALONE.

 

Zaidat OO, Saurez JL, Santillan C, et al.  "Response to intra-arterial and combined intravenous and intra-arterial thrombolytic therapy in patients with distal internal carotid artery occlusion."  Stroke 2002, 33:  1821-1826.

Bellolio MF, et al.  "Stroke Update 2007:  Better Early Stroke Treatment (BEST)," Emergency Medicine Practice, Augst 2007, Volume 9, Number 8.