Therapeutic strategy for acute ischemic stroke:

A role of intravenous rt-PA and neuroendovascular therapy for MCA trunk occlusion

Abstract

We investigated the treatment outcome of revascularization for acute ischemic stroke and reviewed therapeutic strategy of endovascular therapy and intravenous rt-PA therapy. The purpose of this study is to assess the safety and effectiveness our experiences of intravenous (IV) rt-PA and endovascular therapy for acute ischemic stroke patients who had main trunk (M1) occlusion of middle cerebral artery (MCA).
Revascularization with thrombolytic therapy was performed in 57 acute ischemic stroke patients who had MCA (M1) occlusion. since 2002. IV rt-PA and endovascular therapy were performed in 27 and 30 patients, respectively. IV rt-PA therapy was indicated for patients of less than 3 hours from symptom onset. Endovascular therapy was indicated for patients beyond three hours that had DWI/PWI mismatch and for contraindication of rt-PA. Mean time from onset to treatment was 2.2 hours in rt-PA group and 5.3 hours in endovascular group.
Recanalization rate were 56% in rt-PA group and 90% in endovascular group. Symptomatic intracranial hemorrhagic transformation was observed in 7.4% in rt-PA group and 3.3% in endovascular group. Good outcome (mRS 0-2) at 3 months was observed in 52% in rt-PA group and 53% in endovascular group.
Neuroendovascular therapy after patients' selection by DWI/PWI MRI indicates an important role for acute ischemic stroke patients who have occlusions of main trunk of middle cerebral artery.