Intra-arterial thrombolysis for acute ischemic stroke: Preliminary experience with platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy

Vivek R. Deshmukh, David J. Fiorella, Felipe C. Albuquerque, James Frey, Murray Flaster, Robert C. Wallace, Robert F. Spetzler, Cameron McDougall

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To evaluate the safety profile of platelet glycoprotein IIb/IIIa inhibitors administered as adjunctive therapy to patients with large-vessel occlusion and acute ischemic stroke refractory to pharmacological thrombolysis with recombinant tissue plasminogen activator (rtPA) and mechanical disruption, balloon angioplasty, or both. METHODS: Twenty-one patients (mean age, 62 yr; range, 29-88 yr) met the following criteria: 1) large-vessel occlusion and acute ischemic stroke syndrome at presentation, 2) failure to recanalize after administration of rtPA (intra-arterial and/or intravenous) with or without mechanical thrombolysis, and 3) subsequent treatment with IIb/IIIa inhibitors (intra-arterial or intravenous). RESULTS: Eleven patients had ischemia in the dominant hemisphere, 8 in the vertebrobasilar system, and 2 in the nondominant hemisphere. Twelve patients received intravenous rtPA without significant improvement; 9 patients were not candidates for intravenous rtPA. All patients received intra-arterial rtPA. The IIb/IIIa inhibitors were administered intravenously in 3 patients, intra-arterially in 16, and both intravenously and intra-arterially in 2. Balloon angioplasty was performed in 18 patients. Complete or partial recanalization was achieved in 17 of the 21 patients. After thrombolysis, 15 improved clinically. Three patients (14%) sustained an asymptomatic intracerebral hemorrhage after thrombolytic therapy. No patient was clinically worse after intervention. At last follow-up (mean, 8.5 mo), 13 patients were functionally independent (modified Rankin score, 0-3) and 8 were disabled or dead. CONCLUSION: IIb/IIIa inhibitors are an alternative for achieving recanalization. The risk of hemorrhage may be low. As part of an escalating protocol that includes pharmacological and mechanical thrombolysis, IIb/IIIa inhibitors may improve clinical outcomes.

Original languageEnglish (US)
Pages (from-to)46-54
Number of pages9
JournalNeurosurgery
Volume56
Issue number1
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

Fingerprint

Integrin beta3
Platelet Glycoprotein GPIIb-IIIa Complex
Stroke
Tissue Plasminogen Activator
Mechanical Thrombolysis
Therapeutics
Balloon Angioplasty
Pharmacology
Thrombolytic Therapy
Cerebral Hemorrhage

Keywords

  • Acute ischemic stroke
  • Platelet glycoprotein IIb/IIIa inhibitors
  • Thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Intra-arterial thrombolysis for acute ischemic stroke : Preliminary experience with platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy. / Deshmukh, Vivek R.; Fiorella, David J.; Albuquerque, Felipe C.; Frey, James; Flaster, Murray; Wallace, Robert C.; Spetzler, Robert F.; McDougall, Cameron.

In: Neurosurgery, Vol. 56, No. 1, 01.01.2005, p. 46-54.

Research output: Contribution to journalArticle

Deshmukh, Vivek R. ; Fiorella, David J. ; Albuquerque, Felipe C. ; Frey, James ; Flaster, Murray ; Wallace, Robert C. ; Spetzler, Robert F. ; McDougall, Cameron. / Intra-arterial thrombolysis for acute ischemic stroke : Preliminary experience with platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy. In: Neurosurgery. 2005 ; Vol. 56, No. 1. pp. 46-54.
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T2 - Preliminary experience with platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy

AU - Deshmukh, Vivek R.

AU - Fiorella, David J.

AU - Albuquerque, Felipe C.

AU - Frey, James

AU - Flaster, Murray

AU - Wallace, Robert C.

AU - Spetzler, Robert F.

AU - McDougall, Cameron

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AB - OBJECTIVE: To evaluate the safety profile of platelet glycoprotein IIb/IIIa inhibitors administered as adjunctive therapy to patients with large-vessel occlusion and acute ischemic stroke refractory to pharmacological thrombolysis with recombinant tissue plasminogen activator (rtPA) and mechanical disruption, balloon angioplasty, or both. METHODS: Twenty-one patients (mean age, 62 yr; range, 29-88 yr) met the following criteria: 1) large-vessel occlusion and acute ischemic stroke syndrome at presentation, 2) failure to recanalize after administration of rtPA (intra-arterial and/or intravenous) with or without mechanical thrombolysis, and 3) subsequent treatment with IIb/IIIa inhibitors (intra-arterial or intravenous). RESULTS: Eleven patients had ischemia in the dominant hemisphere, 8 in the vertebrobasilar system, and 2 in the nondominant hemisphere. Twelve patients received intravenous rtPA without significant improvement; 9 patients were not candidates for intravenous rtPA. All patients received intra-arterial rtPA. The IIb/IIIa inhibitors were administered intravenously in 3 patients, intra-arterially in 16, and both intravenously and intra-arterially in 2. Balloon angioplasty was performed in 18 patients. Complete or partial recanalization was achieved in 17 of the 21 patients. After thrombolysis, 15 improved clinically. Three patients (14%) sustained an asymptomatic intracerebral hemorrhage after thrombolytic therapy. No patient was clinically worse after intervention. At last follow-up (mean, 8.5 mo), 13 patients were functionally independent (modified Rankin score, 0-3) and 8 were disabled or dead. CONCLUSION: IIb/IIIa inhibitors are an alternative for achieving recanalization. The risk of hemorrhage may be low. As part of an escalating protocol that includes pharmacological and mechanical thrombolysis, IIb/IIIa inhibitors may improve clinical outcomes.

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