Inpharma 1354 - 7 Sep 2002
IV/IA vs IA thrombolytics for acutestroke
IV followed by intra-arterial (IA) therapy with alteplase[rt-PA] is at least as effective as IA urokinase therapy inpatients with ischaemic stroke due to occlusion of thedistal internal carotid artery, report US-basedresearchers.1
They retrospectively analysed data from a universityhospital-based stroke database involving 207 suchpatients presenting within 6 hours of stroke onset whoreceived thrombolytic therapy between 1995 and 2000.Of these, 101 received IA thrombolytics and the precisesite of vascular occlusion could be identified accuratelyvia cerebral angiography. 18 of the 101 patients werefound to have distal occlusion of the internal carotidartery. 13 patients received IA urokinase therapy and theremaining 5 patients received a combination of IV and IAalteplase therapy.
The rate of any angiographic recanalisation was 80%for patients receiving combination IV/IA alteplasetherapy, compared with 62% for IA urokinase recipients;the between-group difference was not significant. Theincidence of symptomatic intracerebral haemorrhagewithin the first 24 hours was 20% for the IV/IA alteplasegroup, compared with 15% for the IA urokinase group.
Inhospital mortality was significantly lower in the IV/IA alteplase group, compared with the IA urokinasegroup (20% vs 62%), but there was no significantdifference in National Institutes of Health Stroke Scale(NIHSS) scores at 5 days (8 vs 12, respectively). Therewas a significant correlation between increasing NIHSSscore and mortality. At 24 hours, NIHSS scores haddecreased from baseline by a mean of 3 points in IAurokinase recipients and by > 4 points in IV/IA alteplaserecipients.
With regard to IA or combination IA/IV acute stroketreatment, Dr David Tong from the Stanford StrokeCenter, California, US, says that the current study addslittle new information to the debate.2 In his opinion, IValteplase should still be considered the mainstay ofacute stroke treatment in most patients, and alltheoretically superior approaches need to be rigorouslytested to confirm their effectiveness before they may beadopted into routine clinical practice.1. Zaidat OO, et al. Response to intra-arterial and combined intravenous and intra-
arterial thrombolytic therapy in patients with distal internal carotid arteryocclusion. Stroke 33: 1821-1827, Jul 2002.
2. Tong DD. Intra-arterial thrombolytic therapy for acute stroke: the debatecontinues. Stroke 33: 1827, Jul 2002.
Inpharma 7 Sep 2002 No. 13541173-8324/10/1354-0001/$14.95 Adis 2010 Springer International Publishing AG. All rights reserved