Efficacy of Intra-Arterial vs. Intravenous tPA Monotherapy in  Acute Ischemic Stroke Treatment

Emrah Keskin; Gökhan Özdemir; Mehmetselim Gel

Makale detayları

Efficacy of Intra-Arterial vs. Intravenous tPA Monotherapy in Acute Ischemic Stroke Treatment

Yazarlar:

Emrah Keskin | Gökhan Özdemir | Mehmetselim Gel

Yayıncı:

Zonguldak Bulent Ecevit University

Ana Başlıklar:

Beyin ve Sinir Cerrahisi (Nöroşirurji)

Dergi:

Batı Karadeniz Tıp Dergisi Vol.9 Issue 1, pp.98-106

Belge Tipi:

Makale

Yayın Tarihi:

4/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001347358

pISSN:

2822-4302

Anahtar kelimeler:

Özet:

 Aim: The method and timing of administration of tissue plasminogen activator tPA in the treatment of acute ischemic stroke AIS remain unclear. In our study, we aimed to compare the effectiveness of intra-arterial IA-tPA compared to intra-venous IV-tPA in AIS. Material and Methods: Patients with AIS received IV-tPA within one hundred and eight minutes or IA-tPA within the first six hours. Before both treatments, their conditions were evaluated and treatments were performed. AIS patients were divided into those receiving IV alteplase maximum 0.90 mgkg and those receiving IA alteplase maximum 0.30 mgkg. Demographic characteristics, systemic diseases and clinical outcomes were evaluated in both groups. Results: It was observed that the clinical findings of the patients in the IA group were worse at the time of admission, but were better than those in the IV group after the procedure. While the ICH rate was similar in both groups p0.817; the recanalization rate was higher in the IA group compared to the IV group p0.001. Patients receiving IA treatment with alteplase doses of 20 mg or less had better clinical improvement p  0.020. In the IA group, the relationship between recanalization rate and the time of the onset of early treatment was statistically significant p  0.007. Conclusion: According to the findings of our study, IA administration of tPA in the treatment of AIS is a more effective and applicable treatment option than IV administration. In addition, since higher recanalization rates and better clinical outcomes are observed in patients who receive IA-tPA treatment in the early period, more effective results can be obtained, especially in patients with large vessel occlusion.

 Aim: The method and timing of administration of tissue plasminogen activator tPA in the treatment of acute ischemic stroke AIS remain unclear. In our study, we aimed to compare the effectiveness of intra-arterial IA-tPA compared to intra-venous IV-tPA in AIS. Material and Methods: Patients with AIS received IV-tPA within one hundred and eight minutes or IA-tPA within the first six hours. Before both treatments, their conditions were evaluated and treatments were performed. AIS patients were divided into those receiving IV alteplase maximum 0.90 mgkg and those receiving IA alteplase maximum 0.30 mgkg. Demographic characteristics, systemic diseases and clinical outcomes were evaluated in both groups. Results: It was observed that the clinical findings of the patients in the IA group were worse at the time of admission, but were better than those in the IV group after the procedure. While the ICH rate was similar in both groups p0.817; the recanalization rate was higher in the IA group compared to the IV group p0.001. Patients receiving IA treatment with alteplase doses of 20 mg or less had better clinical improvement p  0.020. In the IA group, the relationship between recanalization rate and the time of the onset of early treatment was statistically significant p  0.007. Conclusion: According to the findings of our study, IA administration of tPA in the treatment of AIS is a more effective and applicable treatment option than IV administration. In addition, since higher recanalization rates and better clinical outcomes are observed in patients who receive IA-tPA treatment in the early period, more effective results can be obtained, especially in patients with large vessel occlusion.

 Aim: The method and timing of administration of tissue plasminogen activator tPA in the treatment of acute ischemic stroke AIS remain unclear. In our study, we aimed to compare the effectiveness of intra-arterial IA-tPA compared to intra-venous IV-tPA in AIS. Material and Methods: Patients with AIS received IV-tPA within one hundred and eight minutes or IA-tPA within the first six hours. Before both treatments, their conditions were evaluated and treatments were performed. AIS patients were divided into those receiving IV alteplase maximum 0.90 mgkg and those receiving IA alteplase maximum 0.30 mgkg. Demographic characteristics, systemic diseases and clinical outcomes were evaluated in both groups. Results: It was observed that the clinical findings of the patients in the IA group were worse at the time of admission, but were better than those in the IV group after the procedure. While the ICH rate was similar in both groups p0.817; the recanalization rate was higher in the IA group compared to the IV group p0.001. Patients receiving IA treatment with alteplase doses of 20 mg or less had better clinical improvement p  0.020. In the IA group, the relationship between recanalization rate and the time of the onset of early treatment was statistically significant p  0.007. Conclusion: According to the findings of our study, IA administration of tPA in the treatment of AIS is a more effective and applicable treatment option than IV administration. In addition, since higher recanalization rates and better clinical outcomes are observed in patients who receive IA-tPA treatment in the early period, more effective results can be obtained, especially in patients with large vessel occlusion.

 Amaç: Akut iskemik inme Aİİ tedavisinde doku plazminojen aktivatörünün tPA uygulanma yöntemi ve zamanlaması hala belirsizliğini korumaktadır. Çalışmamızda, Aİİde intra-arteriyel İA-tPAnın intra-venöz İV-tPA ile etkinliğini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Aİİli hastalara yüz sekiz dakika içinde İV-tPA veya ilk altı saat içinde İA-tPA verildi. Her iki tedaviden önce durumları değerlendirildi ve tedaviler uygulandı. Aİİ hastaları İV alteplaz maksimum 0,90 mgkg alanlar ve İA alteplaz maksimum 0,30 mgkg alanlar olarak ayrıldı. Her iki grupta da demografik özellikler, sistemik hastalıklar ve klinik sonuçlar değerlendirildi. Bulgular: İA grubunun çalışmanın başlangıç noktasında İV grubuna göre daha yüksek Ulusal Sağlık Enstitüleri İnme Ölçeği NIHSS ve modifiye Rankin skorları mRS olmasına rağmen, iyi klinik sonuçlar İA grubunda daha iyiydi. Her iki gruptaki intrakranial kanama oranı benzer iken p 0,817; rekanalizasyon oranı İA grubunda İV gruba kıyasla daha yüksekti p0,001. İA grubunda, rekanalizasyon oranı ile erken tedavinin başlama zamanı arasındaki ilişki istatistiksel olarak anlamlıydı p  0,007. Sonuç: Çalışmamızın bulgularına göre Aİİ tedavisinde tPAnın İA uygulanması, İV uygulanmasına göre daha etkili ve uygulanabilir bir tedavi seçeneğidir. Ayrıca erken dönemde İA-tPA tedavisi uygulanan hastalarda daha yüksek rekanalizasyon oranları ve daha iyi klinik sonuçlar gözlendiğinden, özellikle büyük damar tıkanıklığı olan hastalarda daha etkili sonuçlar elde edilebilir.

Makale detayları

Efficacy of Intra-Arterial vs. Intravenous tPA Monotherapy in Acute Ischemic Stroke Treatment

Yazarlar:

Emrah Keskin | Gökhan Özdemir | Mehmetselim Gel

Yayıncı:

Zonguldak Bulent Ecevit University

Ana Başlıklar:

Beyin ve Sinir Cerrahisi (Nöroşirurji)

Dergi:

Batı Karadeniz Tıp Dergisi Vol.9 Issue 1, pp.98-106

Belge Tipi:

Makale

Yayın Tarihi:

4/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001347358

pISSN:

2822-4302

acute ischemic stroke

tPA

intra-arterial

intra-venousakut iskemik inme

tPA

intra-arteriyel

intra-venöz

Sayı

Makale detayları

Yazarlar: Emrah Keskin | Gökhan Özdemir | Mehmetselim Gel

Yayıncı: Zonguldak Bulent Ecevit University

Ana Başlıklar: Beyin ve Sinir Cerrahisi (Nöroşirurji)

Dergi: Batı Karadeniz Tıp Dergisi Vol.9 Issue 1, pp.98-106

Belge Tipi: Makale

Yayın Tarihi: 4/2025

Belge Dili: İngilizce

Document ID (Org No.): 2001347358

pISSN: 2822-4302

Sayı

Yazarlar:

Emrah Keskin | Gökhan Özdemir | Mehmetselim Gel

Yayıncı:

Zonguldak Bulent Ecevit University

Ana Başlıklar:

Beyin ve Sinir Cerrahisi (Nöroşirurji)

Dergi:

Batı Karadeniz Tıp Dergisi Vol.9 Issue 1, pp.98-106

Belge Tipi:

Makale

Yayın Tarihi:

4/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001347358

pISSN:

2822-4302