Reasons to withhold intra-arterial thrombolysis in clinical practice

Isenegger, J; Nedeltchev, K; Arnold, M; Fischer, U; Schroth, G; Remonda, L; Mattle, H P (2006). Reasons to withhold intra-arterial thrombolysis in clinical practice. Journal of neurology, 253(12), pp. 1552-6. Heidelberg: Steinkopff-Verlag; www.steinkopff.springer.de 10.1007/s00415-006-0220-1

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BACKGROUND: In selected stroke centers intra-arterial thrombolysis (IAT) is used for the treatment of acute stroke patients presenting within 6 hours 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 3 hours, 69 (30%) between 3 and 6 hours of symptom onset and 85 (37%) later than 6 hours. 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 6 hours 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 6 hours time window and mild or rapidly improving symptoms.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Nedeltchev, Krassen; Arnold, Marcel; Schroth, Gerhard; Remonda, Luca and Mattle, Heinrich

ISSN:

0340-5354

ISBN:

17219032

Publisher:

Steinkopff-Verlag; www.steinkopff.springer.de

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:46

Last Modified:

26 Jun 2018 13:50

Publisher DOI:

10.1007/s00415-006-0220-1

PubMed ID:

17219032

Web of Science ID:

000243465700004

BORIS DOI:

10.7892/boris.18971

URI:

https://boris.unibe.ch/id/eprint/18971 (FactScience: 1247)

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