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Intra-Arterial Therapy as a Rescue Strategy after Clinically Failed Intravenous Thrombolysis May Increase the Likelihood of a Good Outcome in Patients with Severe Ischaemic Stroke

A Retrospective Two Centre Study

doi: 10.15274/INR-2014-10030

Federico Menetti1, Luca Verganti1, Andrea Zini1, Stefano Vallone1, Paolo Carpeggiani1, Tommy Andersson2

1 Stroke Unit, Department of Neuroscience, “S. Agostino Estense” Hospital; Modena, Italy
2 Karolinska University Hospital; Stockholm, Sweden


Key words: acute ischaemic stroke, rescue therapy, intravenous thrombolysis, intra-arterial treatment

Summary

The purpose of this study was to evaluate the efficacy and safety of intra-arterial therapy as a rescue strategy after clinically failed intravenous thrombolysis (IVT) in acute ischaemic stroke patients.
We conducted a retrospective analysis of consecutive acute ischaemic stroke patients treated with rescue therapy. The results from this study group were compared with those obtained from a control group consisting of 260 consecutive patients treated with IVT alone.
The study group consisted of 52 patients with a mean age of 63 years and a median NIHSS score at admission of 17. Recanalization was achieved in 92% with a symptomatic haemorrhage rate of 9.6%. Rescue patients admitted with a severe stroke (NIHSS score >12) had a significantly better outcome at 90 days compared to patients with the same score but treated with IVT alone. No difference was seen for patients with a lower score at admission.
This study indicates that rescue therapy may increase the proportion of patients with independent outcome if presenting with a severe stroke (NIHSS score >12) without increasing the rate of symptomatic haemorrhage.

Tommy Anderson, MD, PhD
Department of Neuroradiology
Karolinska University Hospital
Karolinska vägen 1
Stockholm SE-17176, Sweden
Tel.: 46-73-9661917
E-mail: tommy.andersson@karolinska.se

Volume 20 - No. 3 - May/June 2014

Create date: 14/03/2014 | Last update: 14/03/2014