Journal of Korean Neurosurgical Society

  • 제66권2호
  • /
  • Pages.144-154
  • /
  • 2023
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Recanalization Rate and Clinical Outcomes of Intravenous Tissue Plasminogen Activator Administration for Large Vessel Occlusion Stroke Patients

  • Min-Hyung Lee (Department of Neurosurgery Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sang-Hyuk Im (Department of Neurosurgery Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kwang Wook Jo (Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Do-Sung Yoo (Department of Neurosurgery Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2022.05.10
  • 심사 : 2022.09.17
  • 발행 : 2023.03.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Stroke caused from large vessel occlusion (LVO) has emerged as the most common stroke subtype worldwide. Intravenous tissue plasminogen activator administration (IV-tPA) and additional intraarterial thrombectomy (IA-Tx) is regarded as standard treatment. In this study, the authors try to find the early recanalization rate of IV-tPA in LVO stroke patients. Methods : Total 300 patients undertook IA-Tx with confirmed anterior circulation LVO, were analyzed retrospectively. Brain computed tomography angiography (CTA) was the initial imaging study and acute stroke magnetic resonance angiography (MRA) followed after finished IV-tPA. Early recanalization rate was evaluated by acute stroke MRA within 2 hours after the IV-tPA. In 167 patients undertook IV-tPA only and 133 non-recanalized patients by IV-tPA, additional IA-Tx tried (IV-tPA + IA-Tx group). And 131 patients, non-recanalized by IV-tPA (IV-tPA group) additional IA-Tx recommend and tried according to the patient condition and compliance. Results : Early recanalization rate of LVO after IV-tPA was 12.0% (36/300). In recanalized patients, favorable outcome (modified Rankin Scale, 0-2) was 69.4% (25/36) while it was 32.1% (42/131, p<0.001) in non-recanalized patients. Among 133 patients, non-recanalized after intravenous recombinant tissue plasminogen activator and undertook additional IA-Tx, the clinical outcome was better than not undertaken additional IA-Tx (favorable outcome was 42.9% vs. 32.1%, p=0.046). Analysis according to the perfusion/diffusion (P/D)-mismatching or not, in patient with IV-tPA with IA-Tx (133 patients), favorable outcome was higher in P/D-mismatching patient (52/104; 50.0%) than P/D-matching patients (5/29; 17.2%; p=0.001). Which treatment tired, P/D-mismatching was favored in clinical outcome (iv-tPA only, p=0.008 and IV-tPA with IA-Tx, p=0.001). Conclusion : The P/D-mismatching influences on the recanalization and clinical outcomes of IV-tPA and IA-Tx. The authors would like to propose that we had better prepare IA-Tx when LVO is diagnosed on initial diagnostic imaging. Furthermore, if the patient shows P/D-mismatching on MRA after IV-tPA, additional IA-Tx improves treatment results and lessen the futile recanalization.

키워드

과제정보

Authors appreciate the help of Neurosurgical nurse specialist (Min-Hee Kim, RN. & Hae-Sun Jung, RN.) to collect the data and the grammatical review of our manuscript by Ann C Rice, PhD of the J. Sargeant Reynolds Community College, Richmond, VA, USA.

참고문헌

  1. Abe O, Aoki S, Shirouzu I, Kunimatsu A, Hayashi N, Masumoto T, et al. : MR imaging of ischemic penumbra. Eur J Radiol 46 : 67-78, 2003 https://doi.org/10.1016/S0720-048X(02)00329-7
  2. Albers GW, Thijs VN, Wechsler L, Kemp S, Schlaug G, Skalabrin E, et al. : Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 60 : 508-517, 2006 https://doi.org/10.1002/ana.20976
  3. Aoki J, Kimura K, Shibazaki K, Sakamoto Y : DWI-ASPECTS as a predictor of dramatic recovery after intravenous recombinant tissue plasminogen activator administration in patients with middle cerebral artery occlusion. Stroke 44 : 534-537, 2013 https://doi.org/10.1161/STROKEAHA.112.675470
  4. Astrup J, Siesjo BK, Symon L : Thresholds in cerebral ischemia - the ischemic penumbra. Stroke 12 : 723-725, 1981 https://doi.org/10.1161/01.STR.12.6.723
  5. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. : A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372 : 11-20, 2015 https://doi.org/10.1056/NEJMoa1411587
  6. Berrouschot J, Sterker M, Bettin S, Koster J, Schneider D : Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care. Intensive Care Med 24 : 620-623, 1998 https://doi.org/10.1007/s001340050625
  7. Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, et al. : Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 41 : 2254-2258, 2010 https://doi.org/10.1161/STROKEAHA.110.592535
  8. Broderick JP, Berkhemer OA, Palesch YY, Dippel DW, Foster LD, Roos YB, et al. : Endovascular therapy is effective and safe for patients with severe ischemic stroke: pooled analysis of interventional management of stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data. Stroke 46 : 3416-3422, 2015 https://doi.org/10.1161/STROKEAHA.115.011397
  9. Butcher KS, Parsons M, MacGregor L, Barber PA, Chalk J, Bladin C, et al. : Refining the perfusion-diffusion mismatch hypothesis. Stroke 36 : 1153-1159, 2005 https://doi.org/10.1161/01.STR.0000166181.86928.8b
  10. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. : Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372 : 1009-1018, 2015 https://doi.org/10.1056/NEJMoa1414792
  11. Caplan LR : Intracranial large artery occlusive disease. Curr Neurol Neurosci Rep 8 : 177-181, 2008 https://doi.org/10.1007/s11910-008-0028-8
  12. Caplan LR, Gorelick PB, Hier DB : Race, sex and occlusive cerebrovascular disease: a review. Stroke 17 : 648-655, 1986 https://doi.org/10.1161/01.STR.17.4.648
  13. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, et al. : Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352 : 1305-1316, 2005 https://doi.org/10.1056/NEJMoa043033
  14. Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R, et al. : Endovascular treatment for acute ischemic stroke. N Engl J Med 368 : 904-913, 2013 https://doi.org/10.1056/NEJMoa1213701
  15. Davis S, Donnan GA : Time is penumbra: imaging, selection and outcome. the Johann Jacob Wepfer award 2014. Cerebrovasc Dis 38 : 59-72, 2014 https://doi.org/10.1159/000365503
  16. De Silva DA, Brekenfeld C, Ebinger M, Christensen S, Barber PA, Butcher KS, et al. : The benefits of intravenous thrombolysis relate to the site of baseline arterial occlusion in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Stroke 41 : 295-299, 2010 https://doi.org/10.1161/STROKEAHA.109.562827
  17. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. : Intra-arterial prourokinase for acute ischemic stroke. the PROACT II study: a randomized controlled trial. prolyse in acute cerebral thromboembolism. JAMA 282 : 2003-2011, 1999 https://doi.org/10.1001/jama.282.21.2003
  18. Gorelick PB, Wong KS, Bae HJ, Pandey DK : Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke 39 : 2396-2399, 2008 https://doi.org/10.1161/STROKEAHA.107.505776
  19. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. : Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372 : 1019-1030, 2015 https://doi.org/10.1056/NEJMoa1414905
  20. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. : Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359 : 1317-1329, 2008 https://doi.org/10.1056/NEJMoa0804656
  21. Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R : 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53 : 309-315, 1996 https://doi.org/10.1001/archneur.1996.00550040037012
  22. Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB, et al. : Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 8 : 326-333, 2009 https://doi.org/10.1016/S1474-4422(09)70047-X
  23. Hong KS, Ko SB, Yu KH, Jung C, Park SQ, Kim BM, et al. : Update of the Korean clinical practice guidelines for endovascular recanalization therapy in patients with acute ischemic stroke. J Stroke 18 : 102-113, 2016 https://doi.org/10.5853/jos.2015.01655
  24. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, et al. : Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 375 : 1119-1130, 2016 https://doi.org/10.1056/NEJMoa1605215
  25. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. : Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372 : 2296-2306, 2015 https://doi.org/10.1056/NEJMoa1503780
  26. Khatri P, Abruzzo T, Yeatts SD, Nichols C, Broderick JP, Tomsick TA, et al. : Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology 73 : 1066-1072, 2009 https://doi.org/10.1212/WNL.0b013e3181b9c847
  27. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, et al. : A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368 : 914-923, 2013 https://doi.org/10.1056/NEJMoa1212793
  28. Larrue V, von Kummer RR, Muller A, Bluhmki E : Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke 32 : 438-441, 2001 https://doi.org/10.1161/01.STR.32.2.438
  29. Lewandowski CA, Frankel M, Tomsick TA, Broderick J, Frey J, Clark W, et al. : Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke: Emergency Management of Stroke (EMS) bridging trial. Stroke 30 : 2598-2605, 1999 https://doi.org/10.1161/01.STR.30.12.2598
  30. Lin J, Frontera JA : Decompressive hemicraniectomy for large hemispheric strokes. Stroke 52 : 1500-1510, 2021 https://doi.org/10.1161/STROKEAHA.120.032359
  31. Mazighi M, Serfaty JM, Labreuche J, Laissy JP, Meseguer E, Lavallee PC, et al. : Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. Lancet Neurol 8 : 802-809, 2009
  32. Mishra SM, Dykeman J, Sajobi TT, Trivedi A, Almekhlafi M, Sohn SI, et al. : Early reperfusion rates with IV tPA are determined by CTA clot characteristics. AJNR Am J Neuroradiol 35 : 2265-2272, 2014 https://doi.org/10.3174/ajnr.A4048
  33. Mlynash M, Lansberg MG, De Silva DA, Lee J, Christensen S, Straka M, et al. : Refining the definition of the malignant profile: insights from the DEFUSE-EPITHET pooled data set. Stroke 42 : 1270-1275, 2011 https://doi.org/10.1161/STROKEAHA.110.601609
  34. Muchada M, Rodriguez-Luna D, Pagola J, Flores A, Sanjuan E, Meler P, et al. : Impact of time to treatment on tissue-type plasminogen activator-induced recanalization in acute ischemic stroke. Stroke 45 : 2734-2738, 2014 https://doi.org/10.1161/STROKEAHA.114.006222
  35. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group : Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333 : 1581-1587, 1995 https://doi.org/10.1056/NEJM199512143332401
  36. Paciaroni M, Agnelli G, Corea F, Ageno W, Alberti A, Lanari A, et al. : Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome: results of a prospective multicenter study. Stroke 39 : 2249-2256, 2008 https://doi.org/10.1161/STROKEAHA.107.510321
  37. Paciaroni M, Balucani C, Agnelli G, Caso V, Silvestrelli G, Grotta JC, et al. : Systemic thrombolysis in patients with acute ischemic stroke and Internal Carotid ARtery Occlusion: the ICARO study. Stroke 43 : 125-130, 2012 https://doi.org/10.1161/STROKEAHA.111.630624
  38. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. : 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49 : e46-e110, 2018
  39. Rha JH, Saver JL : The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38 : 967-973, 2007 https://doi.org/10.1161/01.STR.0000258112.14918.24
  40. Ribo M, Alvarez-Sabin J, Montaner J, Romero F, Delgado P, Rubiera M, et al. : Temporal profile of recanalization after intravenous tissue plasminogen activator: selecting patients for rescue reperfusion techniques. Stroke 37 : 1000-1004, 2006 https://doi.org/10.1161/01.STR.0000206443.96112.d9
  41. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. : Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372 : 2285-2295, 2015 https://doi.org/10.1056/NEJMoa1415061
  42. Seners P, Turc G, Maier B, Mas JL, Oppenheim C, Baron JC : Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis. Stroke 47 : 2409-2412, 2016 https://doi.org/10.1161/STROKEAHA.116.014181
  43. Tsivgoulis G, Katsanos AH, Schellinger PD, Kohrmann M, Varelas P, Magoufis G, et al. : Successful reperfusion with intravenous thrombolysis preceding mechanical thrombectomy in large-vessel occlusions. Stroke 49 : 232-235, 2018 https://doi.org/10.1161/STROKEAHA.117.019261
  44. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. : Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 379 : 2364-2372, 2012 https://doi.org/10.1016/S0140-6736(12)60738-7
  45. Wei XE, Zhao YW, Lu J, Li MH, Li WB, Zhou YJ, et al. : Timing of recanalization and outcome in ischemic-stroke patients treated with recombinant tissue plasminogen activator. Acta Radiol 56 : 1119-1126, 2015 https://doi.org/10.1177/0284185114545151
  46. Yoo DS, Kim DS, Cho KS, Huh PW, Park CK, Kang JK : Ventricular pressure monitoring during bilateral decompression with dural expansion. J Neurosurg 91 : 953-959, 1999 https://doi.org/10.3171/jns.1999.91.6.0953
  47. Yoo DS, Won YD, Huh PW, Shin HE, Kim KT, Kang SG, et al. : Therapeutic results of intra-arterial thrombolysis after full-dose intravenous tissue plasminogen activator administration. AJNR Am J Neuroradiol 31 : 1536-1540, 2010 https://doi.org/10.3174/ajnr.A2084
  48. Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK : Contrast enhancement and contrast extravasation on computed tomography after intraarterial thrombolysis in patients with acute ischemic stroke. Stroke 35 : 876-881, 2004 https://doi.org/10.1161/01.STR.0000120726.69501.74