Insights Into Intra-arterial Thrombolysis in the Modern Era of Mechanical Thrombectomy

被引：22

作者：

Castonguay, Alicia C. ^{[1
]}

Jumaa, Mouhammad A. ^{[1
]}

Zaidat, Osama O. ^{[2
]}

Haussen, Diogo C. ^{[3
]}

Jadhav, Ashutosh ^{[4
]}

Salahuddin, Hisham ^{[1
]}

Zaidi, Syed F. ^{[1
]}

机构：

[1] Univ Toledo, Dept Neurol, Hlth Sci Campus, Toledo, OH 43606 USA

[2] St Vincent Mercy Hosp, Toledo, OH USA

[3] Emory Univ, Sch Med, Grady Mem Hosp, Dept Neurol & Neurosurg,Marcus Stroke & Neurosci, Atlanta, GA USA

[4] Univ Pittsburgh, Med Ctr, Dept Neurol, Pittsburgh, PA USA

来源：

FRONTIERS IN NEUROLOGY | 2019年 / 10卷

关键词：

intra-arterial; thrombolysis; thrombectomy; stroke; occlusion; ISCHEMIC-STROKE; PA;

D O I：

10.3389/fneur.2019.01195

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose: The role of intra-arterial (IA) thrombolysis in modern endovascular therapy is not well-understood. Here, we surveyed neurointerventionalists to understand their current clinical practices and opinions of IA thrombolysis in the new era of mechanical thrombectomy (MT). Method: A 24-question anonymous survey was distributed via email to the members of the Society of Vascular and Interventional Neurology. Results: One hundred and four responses were included in the analysis. Most respondents were interventional neurologists (76.9%) and had >= 5-years in neuro-interventional practice (80.8%). IA thrombolytics are presently used by 60.6%. Aspiration plus stent-retriever was the most common MT approach used with IA-thrombolysis (66.0%). IA-thrombolysis was used in mainly three approaches: (1) treatment of primary distal occlusions, (2) as rescue after proximal occlusion thrombectomy, and (3) or as adjunct therapy to primary MT approach. The most frequent IA-rtPA dose was 3-10 mg, with 1 mg/min infusion rate (56.6%). 84.9% do not have a standardized protocol for administering IA-rtPA. About half (50.9%) believed there should be no time limit for administering IA lytic if there is a favorable imaging profile, while 30.2% indicated <= 6 h. Most respondents (76.5%) would consider using IA-tenecteplase in a trial setting. Only 12.9% felt there was no role for IA thrombolysis in modern endovascular practice. Respondents with >= 10-years' experience were less supportive of the future of IA lytic (98.0 vs. 76.4%, p = 0.006). Conclusion: IA-thrombolysis is currently used in clinical practice; however, there is no clear consensus on best practices or criteria for administration. Further studies are needed to define the role of IA-thrombolysis in the context of MT.

引用

页数：7

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