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Reasons to withhold intra-arterial thrombolysis in clinical practice

Isenegger, J. ; Nedeltchev, K. ; Arnold, M. ; Fischer, U. ; Schroth, G. ; Remonda, L. ; Mattle, H.P.

In: Journal of Neurology, 2006, vol. 253, no. 12, p. 1552-1556

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    Titre
    • Reasons to withhold intra-arterial thrombolysis in clinical practice
    Auteur
    • Isenegger, J.. Dept. of Internal Medicine, University of Bern, 3010, Bern, Switzerland
    • Nedeltchev, K.. Dept. of Neurology, University of Bern, 3010, Inselspital, Bern, Switzerland
    • Arnold, M.. Dept. of Neurology, University of Bern, 3010, Inselspital, Bern, Switzerland
    • Fischer, U.. Dept. of Internal Medicine, University of Bern, 3010, Bern, Switzerland
    • Schroth, G.. Dept. of Neuroradiology, University of Bern, 3010, Inselspital, Bern, Switzerland
    • Remonda, L.. Dept. of Neuroradiology, University of Bern, 3010, Inselspital, Bern, Switzerland
    • Mattle, H.P.. Dept. of Neurology, University of Bern, 3010, Inselspital, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Journal of Neurology, 2006, vol. 253, no. 12, p. 1552-1556. Steinkopff-Verlag; www.steinkopff.springer.de
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:309544
    Summary
    Background: In selected stroke centers intra-arterial thrombolysis (IAT) is used for the treatment of acute stroke patients presenting within 6hours of symptom onset. However, data about eligibility of acute stroke patients for IAT in clinical practice are very scarce. Methods: We collected prospectively data on indications advising for or against IAT of 230 consecutive stroke patients in a tertiary stroke center. Results: 76 patients (33.0%) presented within 3hours, 69 (30%) between 3 and 6hours of symptom onset and 85 (37%) later than 6hours. Arteriography was performed in 71 patients (31%) and IAT in 46 (20%). In 11 patients no or only peripheral branch occlusions were seen on arteriography and therefore IAT was not performed. In 9 patients the ICA was occluded and barred IAT and in five anatomical or technical difficulties made IAT impossible. 72 patients presenting within 6hours did not undergo arteriography and thrombolysis, mostly because of mild (n=44) or rapidly improving neurological deficits (n=13). Other reasons to withhold IAT were CT and/or clinical findings suggesting lacunar stroke due to small vessel occlusion (n=7), limiting comorbidty (n=7) and baseline international normalized ratio>1.7 (n=1). Conclusions: A third of the patients underwent diagnostic arteriography and one fifth received IAT. The most important reasons to withhold thrombolysis were presentation beyond the 6hours time window and mild or rapidly improving symptoms