Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T03:44:57.975Z Has data issue: false hasContentIssue false
  • English
  • Français

Turning a stroke into a TIA: curative thrombolysis with combined intravenous and intra-arterial tPA

Published online by Cambridge University Press:  21 May 2015

David J. Gladstone ,
Richard I. Aviv ,
Babak Jahromi ,
Sandra E. Black ,
Devra Baryshnik ,
Rochelle Caratao  and
Allan J. Fox
David J. Gladstone*
Affiliation:
North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ont. Heart and Stroke Foundation Centre for Stroke Recovery
Richard I. Aviv
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ont.
Babak Jahromi
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ont.
Sandra E. Black
Affiliation:
North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ont. Heart and Stroke Foundation Centre for Stroke Recovery
Devra Baryshnik
Affiliation:
North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ont.
Rochelle Caratao
Affiliation:
North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ont.
Allan J. Fox
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ont.
*
Division of Neurology and Regional Stroke Centre, A442 Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Ave., Toronto ON M4N 3M5

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Intravenous tissue plasminogen activator (tPA) is standard treatment for eligible patients with acute ischemic stroke, but may be less effective for very severe strokes caused by proximal intracranial artery occlusions. We report the case of a woman with a devastating stroke who recovered completely following emergency revascularization of an occluded proximal middle cerebral artery using a novel treatment approach that combines both intravenous (IV) and intra-arterial (IA) tPA. This case illustrates the potential value of the combined IV–IA thrombolytic approach, which is an emerging investigational treatment strategy for selected patients with severe acute ischemic stroke.

Keywords

acute ischemic strokeintravenous tPAintra-arterial tPAIV-IA thrombolytic approach
Type
Case Report • Observations de cas
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 1 , January 2006 , pp. 54 - 57
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

References

1.Hill, MD, Buchan, AM; Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Thrombolysis for acute is-chemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 2005;172:1307–12.CrossRefGoogle Scholar
2.del Zoppo, GJ, Poeck, K, Pessin, MS, et al. Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol 1992;32:78–86.CrossRefGoogle ScholarPubMed
3.Gacs, G, Fox, AJ, Barnett, HJ, et al. CT visualization of intracranial arterial thromboembolism Stroke 1983;14(5):756–62.CrossRefGoogle ScholarPubMed
4.Tomsick, T, Brott, T, Barsan, W, et al. Prognostic value of the hyperdense middle cerebral artery sign and stroke scale score before ultraearly thrombolytic therapy. AJNR Am J Neuroradiol 1996;17:79–85.Google Scholar
5.Furlan, A, Higashida, R, Wechsler, L, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999;282:2003–11.Google ScholarPubMed
6.Marler, JR, Tilley, BC, Lu, M, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 2000;55:1649–55.Google Scholar
7.Lewandowski, CA, Frankel, M, Tomsick, TA, 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 1999;30:2598–605.Google Scholar
8.IMS Study Investigators. Combined intravenous and intra-arter-ial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke 2004;35:904–11.CrossRefGoogle Scholar
9.Hill, MD, Barber, PA, Demchuk, AM, et al. Acute intravenous-intra-arterial revascularization therapy for severe ischemic stroke. Stroke 2002;33:279–82.CrossRefGoogle ScholarPubMed
10.Flaherty, ML, Woo, D, Kissela, B, et al. Combined IV and intra-arterial thrombolysis for acute ischemic stroke. Neurology 2005;64:386–8.Google Scholar