A critical analysis of intra-arterial thrombolytic doses in acute ischemic stroke treatment

Ameer E. Hassan, Foad Abd-Allah, Saqib A. Chaudhry, Malik M. Adil, Nassir Rostambeigi, Adnan I. Qureshi

Research output: Contribution to journalArticle

Abstract

Background: Intra-arterial thrombolytics (IAT) such as Alteplase, Tenecteplase, and Reteplase are currently used in patients with acute ischemic stroke in varying doses. We evaluated the relationship of IA thrombolytic dose with angiographic recanalization, intracerebral hemorrhage (ICH) rates, and clinical outcomes at three comprehensive stroke centers. Methods: We stratified patients who underwent endovascular treatment into tertiles based on intra-arterial thrombolytic dose administered: lower tertile (range 1.5-5 mg), middle tertile (range 6-10 mg), and upper tertile (range 10.3-68.5 mg) of rt-PA equivalent. The rates of angiographic recanalization, ICH, and favorable clinical outcomes (discharge modified Rankin score [mRS] = 0-2) were ascertained and compared within the three tertiles. Logistic regression analyses were performed to determine the association between IA thrombolytic dosages and angiographic recanalization, ICH, and favorable clinical outcomes after adjusting for potential confounders. Results: A total of 197 patients were treated with IAT; mean age ±SD was 65.6 ± 16 years; 105 (53.3 %) were women. Ninety-one (46.2 %) patients received both IVT and IAT. IA rt-PA equivalent dose was not different between the patients with and without ICH [mean (mg) ± SD, 9.8 ± 6.1 versus 9.8 ± 9.5, p = 0.9]. We did not find any relation between increasing doses of IAT (from 2 to 69 mg rt-PA equivalent) and symptomatic or asymptomatic ICH: (p = 0.1630) and (p = 0.6702), respectively. Multivariate analysis demonstrated that IAT dose was not associated with ICH (OR 1.0, 95 % CI 0.97-1.07, p = 0.3919) or favorable outcome (OR, 1.00, 95 % CI 0.95-1.06, p = 0.7375). In a subset analysis of IVT patients, total doses ranged from 48.2 to 149 mg and were not associated with either symptomatic (p = 0.23) or asymptomatic (p = 0.24) ICHs. Conclusion: Our study demonstrates that IAT in doses up to 69 mg is safe without any evidence of dose-related ICHs even in those patients who had received IVT.

Original languageEnglish (US)
Pages (from-to)119-123
Number of pages5
JournalNeurocritical care
Volume21
Issue number1
DOIs
StatePublished - Aug 2014
Externally publishedYes

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Keywords

  • Acute ischemic stroke
  • Endovascular treatment
  • Outcomes
  • Post-thrombolytic intracerebral hemorrhage
  • Thrombolytics

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Hassan, A. E., Abd-Allah, F., Chaudhry, S. A., Adil, M. M., Rostambeigi, N., & Qureshi, A. I. (2014). A critical analysis of intra-arterial thrombolytic doses in acute ischemic stroke treatment. Neurocritical care, 21(1), 119-123. https://doi.org/10.1007/s12028-013-9859-5