J Cerebrovasc Endovasc Neurosurg.  2017 Dec;19(4):257-267. 10.7461/jcen.2017.19.4.257.

Clinical Results of the Intra-Arterial Thrombolysis with Stent Retriever Device Weather Perfusion Diffusion Mismatching and Intravenous Tissue Plasminogen Activator Administration

• Kim YJ
• Cho KW
• Kim SR
• Yoo DS
• Park HK
• Ji C

• KMID: 2401778
• DOI: http://doi.org/10.7461/jcen.2017.19.4.257

Abstract

OBJECTIVE
Intraarterial thrombolysis (IA-Tx) with stent retriever is accepted as an additional treatment for selected patients and the clinical benefit is well reported. Each intravenous tissue plasminogen activator administration (IV-tPA) and perfusion diffusion mismatching (P/D-mismatching) is well known the beneficial effects for recanalization and clinical outcomes. In this report, authors analyzed the clinical outcomes of additional IA-Tx with retrieval stent device, according to the combined IV-tPA and P/D-mismatching or not.
METHODS
Eighty-one treated IA-Tx with the Solitaire stent retriever device, diagnosed as anterior circulation larger vessel occlusion were included in this study. Computed tomography-angiography (CTA) was done as an initial diagnostic image and acute stroke magnetic resonance image (MRI) followed after the IV-tPA. Forty-two patients were in the tPA group and 39 patients were in the non-tPA group. Recanalization rate, clinically significant hemorrhagic (sICH) and clinical outcomes were recorded according to the IV-tPA and P/D-mismatching.
RESULTS
Recanalization rate was 81.0% in IV-tPA group, and it was 69.2% in non-tPA group (p = 0.017). While sICH were 19.9% and 25.6%, respectively (p = 0.328). Neurologic outcomes did not influence by IV-tPA administration or not. But according to the P/D-mismatching, the recanalization rate and sICH were 91.9% and 16.7% in the mismatched group and 46.7% and 46.7% in the matched group (p = 0.008 and p = 0.019, respectively).
CONCLUSION
For patients treated with IA-Tx with retrieval stent, IV-tPA infusion does not influence on the sICH, recanalization rate and neurologic outcomes. But P/D-mismatching was correlated well with sICH, recanalization rate and clinical outcomes.

Keyword

Throbmolysis; Tissue plasminogen activator; Perfusion image; Diffusion image; Mismatching; Neurologic outcome

MeSH Terms

Diffusion*
Humans
Perfusion*
Research Design
Stents*
Stroke
Tissue Plasminogen Activator*
Weather*
Tissue Plasminogen Activator

Figure

• 

  Fig. 1 Flow diagram of treatment protocol. CT = computed tomography; IV-tPA = intravenous tissue plasminogen activator administration; MRI = magnetic resonance imaging, MRA = magnetic resonance angiography; DWI = diffusion weighted image; PWI = perfusion weighted image; Tx. = treatment; GCS = Glasgow coma scale; EVD = extraventricular drainage.

• 

  Fig. 2 Clinical outcomes evaluated 3 months after the initial treated according to the P/D-mismatching and IV-tPA. P/D-mismatching = perfusion diffusion mismatching; IV-tPA = intravenous tissue plasminogen activator; mRS = modified Rankin Scale.

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