Recanalization rates

A single-center review of 350 acute stroke patients treated with lAT using urokinase showed recanalization rates greater than 75% when additional endovascular techniques (such as mechanical fragmentation of the thrombus, thromboaspiration,... 

The PRO ACT-11 trial was designed to assess the clinical efficacy and safety of lA r-pro-UK. In this study, 180 patients were enrolled in a 2 1 randomization scheme to receive either 9 mg lA r-pro-UK plus 4 hours of low-dose IV heparin, or low-dose IV heparin alone. The primary clinical outcome, the proportion of patients with slight or no disability at 90 days (mRS of < 2), was achieved in 40% of the 121 patients in the r-pro-UK treatment group, compared to 25% of the 59 patients in the control group (absolute benefit 15%, relative benefit 58%, number need to treat = 7 p = 0.04). The recanalization rate (TlMl 2 and 3) was 66% for the r-pro-UK group and 18% for the control group (p < 0.001). Symptomatic ICH within 24 hours occurred in 10% of r-pro-UK patients and 2% of control patients (p = 0.06). All symptomatic ICHs occurred in patients with a baseline NIHSS... 

Ernst et al. performed a retrospective analysis of 20 consecutive patients (median NIHSS 21) who presented within 3 hours of stroke symptoms and were treated using IV rt-PA (0.6 mg/kg) followed by LA rt-PA (up to 0.3 mg/kg or 24 mg, whichever was less, over a maximum period of 2 hours) in 16 of the 20 patients. Despite a high number of ICA occlusions (8/16), TIMI 2 and 3 recanalization rates were... 

No direct comparison trials have been reported between the different thrombolytic agents in acute ischemic stroke. In a retrospective review of the results for acute stroke lAT performed at our center, we have found significantly higher rates of recanalization and good clinical outcome in the era in which lA UK was used versus the era in which UK was not available and lAT with rt-PA was the primary treatment. Conversely, in another retrospective study, Eckert et al. found no major difference between the recanalization rates of UK and rt-PA. 

Stenting of an acutely occluded intracranial vessel may provide fast recanalization by entrapping the thrombus between the stent and the vessel wall. A recent study in which 19 patients with acute occlusions at the ICA terminus n = 8), M1/M2 (n = 7), or basilar artery (n = 4) were treated with balloon-expandable stents showed a TIMI 2 and 3 recanalization rate of 79% and no symptomatic intracranial hemorrhages (Fig. 4.5). ... 

The efficacy of IV thrombolysis in patients with moderate-to-severe strokes due to proximal arterial occlusions is restricted by several factors, including the relatively short therapeutic window, poor recanalization rates as the clot burden increases, restrictive eligibility criteria, and the risk of intracerebral hemorrhage. Endovascular techniques improve the rates of recanalization in this patient population, and appear to increase the likelihood of a good functional outcome. Intravenous thrombolysis... 

The cost of fibrinolytic agents is considerable streptokinase costs about US 100, and rt-PA and its mutants about US 2000, However, these agents have different early (90 minutes) recanalization rates over 50% for front-loaded tissue rt-PA versus only 30% to 35% for streptokinase. Since early patency is correlated with early survival (12), the initial cost of the thrombolytic drug alone is not important. Patients who present early with a large myocardial infarction benefit more from a drug with a high early patency rate than patients presenting late with a small myocardial infarction. 

Kim YS, Garami Z, Mikulik RC for the CLOTBUST Collaborators (2005). Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/ middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke 36 869-871... 

Lin R, Vora N, Zaidi S, Aleu A, Jankowitz B, Thomas A, Gupta R, Horowitz M, Kim S, Reddy V, Hammer M, Uchino K, Wechsler LR, Jovin T Mechanical approaches combined with intra-arterial pharmacological therapy are associated with higher recanalization rates than either intervention alone in revascularization of acute carotid terminus occlusion. Stroke 2009 40 pp. 2092-2097. 

IMS 11 subjects treated with the EKOS catheter and IMS 1 subjects treated with the standard microcatheter demonstrated grade 2-3 recanalization rates at the specific site of arterial occlusion of 73% (24/33) in EKOS-treated subjects vs. 56% (33/59) in standard microcatheter-treated subjects (p=0.11) [57]. This device is being further investigated in the randomized IMS 111 trial. Likewise, enhanced fibrinolysis with intravenous rt-PA can be achieved with the use of continuous 2-MHz transcranial Doppler ultrasonography (CLOTBUST trial) [58]. 

Trial Design Basehne NIHSS Recanalization rates Good clinical outcome (90-day mRS <2) Mortality slCH ... 

---