Thrombolytic therapy intra-arterial

Zaidat OO, Suarez Jl, Santillan C, Sunshine JL, Tarr RW, Paras VH, Selman WR, Landis DM. Response to intra-arterial and combined intravenous and intra-arterial thrombolytic therapy in patients with distal internal carotid artery occlusion. Stroke 2002 33 1821-1826. 

Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19 1216-1222... 

Comparisons between the different intra-arterial thrombolysis trials and between intraarterial thrombolysis and intravenous thrombolysis is hampered by differences in methodology and type of thrombolytic therapy. In addition, within the intra-arterial thrombolysis trials, thrombolytic deUvery has varied between regional into a parent vessel of the thrombosed vessel, local into the affected artery and into the thrombus itself, or combinations of these methods. In addition, the infusion process has been variable, ranging from continuous to pulsed infusion. Some studies have allowed physical clot dispersion using the tip of the microcatheter while this was prohibited in others, for instance in the PROACT trials. 

Kim DJ, Kim DI, Byun JS, Jung JY, Suh SH, Kim EY, Heo JH Intra-arterial thrombolytic therapy for hyperacute ischemic stroke caused by tandem occlusion. Cerebrovasc Dis 2008 26 pp. 184-189. 

Importantly, the identification of ischemic brain tissue by CT not only defines regions likely to infarct, but also may predict outcome and response to intravenous (IV) or intra-arterial (lA) thrombolytic therapy [13]. CT scanning is most commonly used to exclude the presence of intracranial hemorrhage and a large established infarction. In addition, unenhanced CT findings... 

The stability identified in these patients was most likely due to excellent collateral circulation in these patients. Patients with excellent collateral circulation were selected through the inclusion criteria of the study. To be eligible for inclusion, patients had to be outside the therapeutic window for tPA, and not eligible for intra-arterial thrombolytic therapy. The other major criterion was that the patient had to have a large diffusion/perfusion mismatch. These two criteria resulted in the selection of patients with relatively... 

Lisboa, R.C., B.D. Jovanovic, and M.J. Alberts, Analysis of the safety and efficacy of intra-arterial thrombolytic therapy in ischemic stroke. Stroke, 2002. 33(12) p. 2866-71. 

Smith WS (2007) Intra-arterial thrombolytic therapy for acute basilar occlusion pro. Stroke 38 701-703... 

SchelUnger PD, Fiebach JB, Mohr A et al (2001) Thrombolytic therapy for ischemic stroke-a review. Part Il-Intra-arterial thrombolysis, vertebrobasilar stroke, phase IV trials, and stroke imaging. Crit Care Med 29 1819-1825... 

There are three absolute contraindications to the initiation of thrombolytic therapy (1) active uncontrollable hemorrhage, (2) likely persistent proximal source of embolization, or (3) neurovascular compromise in the affected extremity, where it is likely that a reperfusion injury such as myonecrosis may develop. Relative contraindications include recent intra-abdominal or intrathoracic surgery, uncontrollable hypertension, a recent intracerebral event that is likely to be hemorrhagic, and possibly the recent use of a porous intra-arterial graft material. Thrombolytic complications are proportional to the duration of therapy and usually consist of hemorrhage, often related to concomitant need for anticoagulation. 

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