This Article Full Text Full Text (PDF) All Versions of this Article: 35/3/705    most recent 01.STR.0000117094.41638.EEv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Straub, S. Articles by Siebler, M. Search for Related Content PubMed PubMed Citation Articles by Straub, S. Articles by Siebler, M. Related Collections Antiplatelets Thrombolysis Platelet function inhibitors Acute Cerebral Infarction Emergency treatment of Stroke Computerized tomography and Magnetic Resonance Imaging

(Stroke. 2004;35:705.)
© 2004 American Heart Association, Inc.

Original Contributions

Systemic Thrombolysis With Recombinant Tissue Plasminogen Activator and Tirofiban in Acute Middle Cerebral Artery Occlusion

Stefan Straub, MD; Ulrich Junghans, MD; Verica Jovanovic, MD; Hans J. Wittsack, PhD; Rüdiger J. Seitz, MD Mario Siebler, MD

From the Department of Neurology (S.S., U.J., V.J., R.J.S., M.S.) and Institute of Diagnostic Radiology (H.J.W.), University Hospital Düsseldorf, Düsseldorf, Germany.

Correspondence to Mario Siebler, MD, Department of Neurology, University Hospital Düsseldorf, Moorenstr 5, D-40225 Düsseldorf, Germany. E-mail Siebler{at}uni-duesseldorf.de

Background and Purpose— In acute ischemic stroke, thrombolytic treatment with recombinant tissue plasminogen activator (rtPA) is limited by a concomitant activation of the coagulatory system, leading to incomplete or delayed reperfusion, microcirculatory disturbances, or even repeated vessel occlusions. Our pilot study sought to assess the therapeutic potential of a new treatment strategy combining rtPA at reduced dosages with a platelet glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitory agent in acute middle cerebral artery occlusion.

Methods— Nineteen patients suffering from acute middle cerebral artery occlusion (Thrombolysis in Myocardial Infarction [TIMI] flow grade 0 to 1) underwent combined intravenous thrombolytic treatment using rtPA at reduced dosages and the GPIIb/IIIa antagonist tirofiban. Stroke MRI (diffusion- and perfusion-weighted imaging) and MR angiography were performed at baseline and between days 1 and 2 after treatment. Clinical scores (National Institutes of Health Stroke Scale and modified Rankin Scale) were assessed at baseline and after 1 week.

Results— Middle cerebral artery recanalization (TIMI flow grade 2 and 3) occurred in 13 of 19 patients (68%). The ischemic lesion on follow-up MRI was significantly smaller in patients with recanalization compared with those without recanalization (P=0.001). Only patients with recanalization improved neurologically (P<0.001). Because no symptomatic hemorrhage was observed, the power of our study to detect a symptomatic bleeding rate of 8% was at least 80%.

Conclusions— Combined thrombolysis with a GPIIb/IIIa antagonist and rtPA at reduced dosages is promising but cannot be recommended for general use before prospective randomized clinical trials are completed.

Key Words: intracranial embolism and thrombosis • magnetic resonance imaging • platelet glycoprotein GPIIb-IIIa complex • tissue plasminogen activator

This article has been cited by other articles:

				H. Wang, D. Wang, K. Fraser, J. Swischuk, and P. Elwood Emergent Combined Intracranial Thrombolysis and Carotid Stenting in the Hyperacute Management of Stroke Patients with Severe Cervical Carotid Stenosis AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1162 - 1166. [Abstract] [Full Text] [PDF]

				P. Khatri and S. E. Kasner Ischemic strokes after cardiac catheterization: opportune thrombolysis candidates? Arch Neurol, June 1, 2006; 63(6): 817 - 821. [Abstract] [Full Text] [PDF]

				R. Gupta, N. A. Vora, M. B. Horowitz, A. H. Tayal, M. D. Hammer, K. Uchino, E. I. Levy, L. R. Wechsler, and T. G. Jovin Multimodal Reperfusion Therapy for Acute Ischemic Stroke: Factors Predicting Vessel Recanalization Stroke, April 1, 2006; 37(4): 986 - 990. [Abstract] [Full Text] [PDF]

				S. Mangiafico, M. Cellerini, P. Nencini, G. Gensini, and D. Inzitari Intravenous Glycoprotein IIb/IIIa Inhibitor (Tirofiban) followed by Intra-Arterial Urokinase and Mechanical Thrombolysis in Stroke AJNR Am. J. Neuroradiol., November 1, 2005; 26(10): 2595 - 2601. [Abstract] [Full Text] [PDF]

				S. Mangiafico, M. Cellerini, P. Nencini, G. Gensini, and D. Inzitari Intravenous Tirofiban With Intra-Arterial Urokinase and Mechanical Thrombolysis in Stroke: Preliminary Experience in 11 Cases Stroke, October 1, 2005; 36(10): 2154 - 2158. [Abstract] [Full Text] [PDF]

				C. A. Molina and J. L. Saver Extending Reperfusion Therapy for Acute Ischemic Stroke: Emerging Pharmacological, Mechanical, and Imaging Strategies Stroke, October 1, 2005; 36(10): 2311 - 2320. [Abstract] [Full Text] [PDF]

				B. Eckert, C. Koch, G. Thomalla, T. Kucinski, U. Grzyska, J. Roether, K. Alfke, O. Jansen, and H. Zeumer Aggressive Therapy With Intravenous Abciximab and Intra-Arterial rtPA and Additional PTA/Stenting Improves Clinical Outcome in Acute Vertebrobasilar Occlusion: Combined Local Fibrinolysis and Intravenous Abciximab in Acute Vertebrobasilar Stroke Treatment (FAST): Results of a Multicenter Study Stroke, June 1, 2005; 36(6): 1160 - 1165. [Abstract] [Full Text] [PDF]

				H. Adams, R. Adams, G. Del Zoppo, and L. B. Goldstein Guidelines for the Early Management of Patients With Ischemic Stroke: 2005 Guidelines Update A Scientific Statement From the Stroke Council of the American Heart Association/American Stroke Association Stroke, April 1, 2005; 36(4): 916 - 923. [Full Text] [PDF]