J 2014

Utility of a rescue endovascular therapy for the treatment of major strokes refractory to full-dose intravenous thrombolysis

VANÍČEK, Jiří, Martin BULIK, Jaroslav BRICHTA and Radim JANČÁLEK

Basic information

Original name

Utility of a rescue endovascular therapy for the treatment of major strokes refractory to full-dose intravenous thrombolysis

Authors

VANÍČEK, Jiří (203 Czech Republic, guarantor, belonging to the institution), Martin BULIK (203 Czech Republic, belonging to the institution), Jaroslav BRICHTA (203 Czech Republic) and Radim JANČÁLEK (203 Czech Republic, belonging to the institution)

Edition

BRITISH JOURNAL OF RADIOLOGY, LONDON, BRITISH INST RADIOLOGY, 2014, 0007-1285

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30000 3. Medical and Health Sciences

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 2.026

RIV identification code

RIV/00216224:14110/14:00077147

Organization unit

Faculty of Medicine

DOI

UT WoS

000334291900006

Keywords in English

ACUTE ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; RECANALIZATION; VALIDATION; RETRIEVER

Tags

Tags

International impact, Reviewed
Změněno: 6/11/2014 15:31, Soňa Böhmová

Abstract

V originále

Objective: Large artery occlusion (LAO) in patients with major stroke predicts poor revascularization by intravenous thrombolysis (IVT) and more likely results in a poor outcome. We focused on the effects of intra- arterial thrombolysis (IAT) and endovascular mechanical recanalization (EMR) as rescue therapies in major strokes refractory to IVT. Methods: A retrospective analysis of 87 patients (National Institutes of Health Stroke Scale >20), who did not respond to full-dose IVT due to LAO, was performed based on their endovascular therapy status. IAT was performed as an intraclot infusion of alteplase, and EMR was provided by the Solitaire device (TM) (Covidien, Dubin, Ireland). The recanalization and 3-month outcome rates after IAT/EMR were correlated with a group of patients who were scheduled to receive endovascular treatment but who underwent only IVT. Results: We achieved successful recanalization by IAT and EMR in 68.7% and 76.1% of patients, respectively. Despite no significant differences in mortality between IAT and EMR, a trend towards better outcomes after IAT and a statistically significant increase for outcome-modified Rankin scale (mRS) 0-3 (45.7%) and mRS 0-2 (34.9%) after EMR was noted when compared with IVT. The degree of recanalization did not correlate with the functional results except for the good-moderate outcome after successful recanalization by EMR. Conclusion: EMR by the Solitaire device is a safe and beneficial method for the rescue treatment of patients with major stroke whose neurological status does not improve and who fail to recanalize the LAO after a 1-h full dose of IVT. Advances in knowledge: The article verifies efficiency of the Solitaire device in major strokes.