Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions

Area of Science:

• Neurology
• Interventional Radiology
• Emergency Medicine

Background:

• Mechanical thrombectomy (MT) improves outcomes in acute ischemic stroke but often fails to achieve complete reperfusion.
• Intra-arterial thrombolysis may enhance reperfusion when MT is unsuccessful.
• The North American Solitaire Stent-Retriever Acute Stroke registry provides data on MT outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of intra-arterial recombinant tissue-type plasminogen activator (rtPA) as rescue therapy (RT) after failed MT.
• To compare outcomes in patients receiving rtPA RT versus those not receiving it following MT for emergent large vessel occlusions.

Main Methods:

• Retrospective analysis of the North American Solitaire Stent-Retriever Acute Stroke registry.
• Inclusion of patients with anterior emergent large vessel occlusions treated with MT.
• Comparison of outcomes between patients receiving intra-arterial rtPA RT and those not receiving it after failed MT.

Main Results:

• Revascularization success was numerically higher (61.2% vs. 46.6%) in the rtPA RT group, though not statistically significant.
• Symptomatic intracranial hemorrhage and mortality rates were similar between groups.
• In a subgroup with M1 occlusions and onset to groin puncture ≤8 hours, rtPA RT significantly increased successful revascularization (77.8% vs. 38.9%, P=0.02).

Conclusions:

• Intra-arterial rtPA as rescue therapy after MT demonstrates a comparable safety and clinical outcome profile.
• Higher reperfusion rates were observed in patients with M1 occlusions treated with rtPA RT.
• Further prospective studies are warranted to define the role of intra-arterial thrombolysis in MT.