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BACKGROUND AND PURPOSE: The purpose of this study was to further investigate the feasibility and safety of a combined intravenous and intra-arterial approach to recanalization for ischemic stroke. METHODS: Subjects, ages 18 to 80, with a baseline NIHSS > or =10 had intravenous recombinant tissue plasminogen activator (rt-PA) started (0.6 mg/kg over 30 minutes) within 3 hours of onset. For subjects with an arterial occlusion at angiography, additional rt-PA was administered via the EKOS micro-infusion catheter or a standard microcatheter at the site of the thrombus up to a total dose of 22 mg over 2 hours of infusion or until thrombolysis. RESULTS: The 81 subjects had a median baseline NIHSS score of 19. The median time to initiation of intravenous rt-PA was 142 minutes as compared with 108 minutes for placebo and 90 minutes for rt-PA-treated subjects in the NINDS rt-PA Stroke Trial (P<0.0001). The 3-month mortality in IMS II subjects was 16% as compared with the mortality of placebo (24%) and rt-PA-treated subjects (21%) in the NINDS rt-PA Stroke Trial. The rate of symptomatic intracerebral hemorrhage in IMS II subjects (9.9%) was not significantly different than that for rt-PA treated subjects in the NINDS t-PA Stroke Trial (6.6%). IMS II subjects had significantly better outcomes at 3 months than NINDS placebo-treated subjects for all end points (OR > or =2.7) and better outcomes than NINDS rt-PA-treated subjects as measured by the Barthel Index and Global Test Statistic. CONCLUSIONS: A randomized trial of standard intravenous rt-PA as compared with a combined intravenous and intra-arterial approach is warranted and has begun.

Original publication

DOI

10.1161/STROKEAHA.107.483131

Type

Journal article

Journal

Stroke

Publication Date

07/2007

Volume

38

Pages

2127 - 2135

Keywords

Adolescent, Adult, Aged, Aged, 80 and over, Biomedical Research, Catheterization, Cerebral Angiography, Cerebrovascular Circulation, Clinical Trials, Phase III as Topic, Emergency Medical Services, Female, Fibrinolytic Agents, Humans, Infusions, Intravenous, Male, Middle Aged, Pilot Projects, Stroke, Thrombolytic Therapy, Time Factors, Tissue Plasminogen Activator