Intraarterial therapy,stroke

The effectiveness of catheter-based intra-arterial therapy to remove residual thrombus after IV rt-PA treatment is being tested in the Interventional Management of Stroke study (IMS-Ill). This study will randomize patients to 0.6 mg/kg IV rt-PA, followed by angiography with additional intra-arterial therapy as indicated, or IV full-dose rt-PA (0.9 mg/kg). A nonrandomized safety study suggested that intraarterial therapy, after 0.6 mg/kg IV rt-PA, could be accomphshed with acceptable rates of sICH. ° ... 

Barnwell SL, Clark WM, Nguyen TT, O Neill OR, Wynn ML, Coull BM. Safety and efficacy of delayed intraarterial urokinase therapy with mechanical clot disruption for thromboembolic stroke. Am J Neuroradiol 1994 15 1817-1822. 

Lisboa RC, Jovanovic BD, Alberts MJ. Analysis of the safety and efficacy of intraarterial thrombol3ftic therapy in ischemic stroke. Stroke 2002 33 2866-2871. 

Lewandowski CA, Frankel M, Tomsick TA et al. (1999). Combined intravenous and intraarterial r-TPA versus intra-arterial therapy of acute ischemic stroke Emergency Management of Stroke (EMS) Bridging Trial. Stroke 30 2598-2605... 

Deshmukh VR, Fiorella DJ, Albuquerque FC et al. Intraarterial thrombolysis for acute ischemic stroke preliminary experience with platelet glycoprotein llb/llla inhibitors as adjunctive therapy. Neurosurgery. 2005 56 46-54 discussion 54-45... 

Cardiovascular A meta-analysis and systemic review were performed to ascertain the relationship between prior warfarin use with subtherapeutic international normalized ratio (INR) and outcome after intravenous or intraarterial thrombolytic therapy in acute ischaemic stroke patients The outcomes were symptomatic intracranial haemorrhage, modified Rankin scale score and mortality. The risk of symptomatic intracranial haemorrhage after thrombolytic therapy was increased in patients using warfarin with subtherapeutic INR levels. However, there was no association between prior warfarin therapy and worsened fxmctional outcome or all-cause death. 

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