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Future role of intraarterial thrombolysis in developing economics

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Presented at

11th World Stroke Congress

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Abstract

Background/Objectives: Current ischemic stroke treatment: intravenous thrombolysis with rt-PA (first 4.5 hours); thrombectomy (TE) within 6– 8 hours. Selective intra-arterial thrombolysis (IAT) with rt-PA can be also feasible. Design/Method: 14 patient with stroke in our hospital underwent IAT. All these patients had severe stroke (NIHSS 15–24 points). Non-contrast CT results were graded by ASPECTS (7–10 points). Selective cerebral angiography showed acute thrombotic occlusion of big vessel (internal carotid artery or M1 segment of middle cerebral artery). The bolus infusion of 2–3 ml of rt-PA was performed which was followed with 1 hour infusion of 20–30 ml of rt-PA. Outcome was evaluated based on CT and NIHSS in 24 hours after infusion and on NIHSS and modified Rankin Scale (mRS) on the 30th day. Results: 8 cases (57,15%) showed the complete recanalization of occluded vessel (TICI 3). 3 cases showed recanalization of occluded vessel to TICI 2b (21,5%) in and 1 case to TICI 2a (7,1%) in 24 hours with 2 patients without recanalization (14,25%). 9 patients (64,25%) showed clinical improvement to 5–7 points on NIHSS, 3 (21,5%) - the same score and 2 (14,25) worsened to 25-27 points. CT data: 3 patients had hemorrhagic transformation, one PH2, two - PH1. 1 month: mRS was 0 in 5 patient, 1 in 2 patient, 2 in 3 patients, 4 - in 1 patient. Mortality: 3 patients. Conclusions: IAT showed good outcome despite the severe stroke: TICI 2b-3 in 78,65% of patients and mRS 0–2 in 71,4% of patients in 1 month. The cost of IAT is comparable to IV rt-PA and lower than TE so this method can be used in developing economics. Further analysis to avoid hemorrhages (21,5%) and mortality (21,5%) in patients should be done.

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© Copyright 2019 Morressier GmbH.
All rights reserved.