Published Online
on September 22, 2005

A more recent version of this article appeared on October 1, 2005

This Article Full Text (PDF) All Versions of this Article: 36/10/2286    most recent 01.STR.0000179043.73314.4fv1 Alert me when this article is cited Alert me if a correction is posted 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 Abou-Chebl, A. Articles by Yadav, J. S. Search for Related Content PubMed PubMed Citation Articles by Abou-Chebl, A. Articles by Yadav, J. S. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Angioplasty Stroke Related Collections Other Treatment Acute Cerebral Infarction Emergency treatment of Stroke Thrombolysis Angioplasty and Stenting

Submitted on March 21, 2005
Accepted on June 16, 2005

Multimodal Therapy for the Treatment of Severe Ischemic Stroke Combining GPIIb/IIIa Antagonists and Angioplasty After Failure of Thrombolysis

Alex Abou-Chebl MD; Christopher T. Bajzer MD; Derk W. Krieger MD; Anthony J. Furlan MD; and Jay S. Yadav MD^*

From the Departments of Neurology (A.A.-C., D.W.K., A.J.F., J.S.Y.) and Cardiovascular Medicine (C.T.B., J.S.Y.), The Cleveland Clinic Foundation, Cleveland, Ohio.

^* To whom correspondence should be addressed. E-mail: yadavj{at}ccf.org.

Background and Purpose--Intraarterial and intravenous thrombolysis are often ineffective for the treatment of acute ischemic stroke and are associated with a significant risk of intracranial hemorrhage (ICH). Multimodal rescue therapy combining mechanical disruption and platelet GPIIb/IIIa receptor antagonists may improve recanalization.

Methods--Patients who did not recanalize with thrombolysis were treated with GPIIb/IIIa antagonists, angioplasty, or an embolectomy device. Treatment was individualized based on vascular anatomy, stroke mechanism, patient status, and symptom duration.

Results--Twelve patients were treated within 3.8±2.2 hours. The mean National Institutes of Health Stroke Scale (NIHSS) score was 19.4±4.1. Six patients had carotid terminus occlusion, whereas 5 had middle cerebral artery and 1 had basilar artery occlusion. The average doses of intraarterial tPA and reteplase were 17.1±8.6 mg and 2±0.6 units, respectively. All patients received either an intravenous or intraarterial abciximab bolus (mean 11.8±5.8mg) and heparin (mean 3278±1716U). Eleven were treated with angioplasty and 4 had mechanical embolectomy or stenting. Complete (8) or partial (3) recanalization was achieved in 11 cases. There was only one (8.3%) symptomatic hemorrhage. Patients had a favorable outcome at discharge (mean NIHSS 8.9±8.7) and 6 (50%) had an NIHSS 4 at discharge.

Conclusions--Multimodal rescue therapy was effective at recanalizing occluded cerebral vessels that failed thrombolysis without an excess risk of ICH.

Key words: acute • angioplasty • endovascular therapy • platelet aggregation inhibitors • stroke • thrombolysis

This article has been cited by other articles:

				E. I. Levy, A. H. Siddiqui, A. Crumlish, K. V. Snyder, E. F. Hauck, D. J. Fiorella, L. N. Hopkins, and J Mocco First Food and Drug Administration-Approved Prospective Trial of Primary Intracranial Stenting for Acute Stroke: SARIS (Stent-Assisted Recanalization in Acute Ischemic Stroke) Stroke, November 1, 2009; 40(11): 3552 - 3556. [Abstract] [Full Text] [PDF]

				R. Lin, N. Vora, S. Zaidi, A. Aleu, B. Jankowitz, A. Thomas, R. Gupta, M. Horowitz, S. Kim, V. Reddy, et al. Mechanical Approaches Combined With Intra-Arterial Pharmacological Therapy Are Associated With Higher Recanalization Rates Than Either Intervention Alone in Revascularization of Acute Carotid Terminus Occlusion Stroke, June 1, 2009; 40(6): 2092 - 2097. [Abstract] [Full Text] [PDF]

				R.G. Nogueira, L.H. Schwamm, and J.A. Hirsch Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 649 - 661. [Abstract] [Full Text] [PDF]

				A. M. Pancioli Combination Pharmacotherapy for Achievement and Maintenance of Vascular Patency Stroke, March 1, 2009; 40(3_suppl_1): S99 - S102. [Abstract] [Full Text] [PDF]

				G. Stoll, C. Kleinschnitz, and B. Nieswandt Molecular mechanisms of thrombus formation in ischemic stroke: novel insights and targets for treatment Blood, November 1, 2008; 112(9): 3555 - 3562. [Abstract] [Full Text] [PDF]

				D. M. Pelz, E. I. Levy, and L. N. Hopkins Advances in Interventional Neuroradiology 2006 Stroke, February 1, 2007; 38(2): 232 - 234. [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]

				D. Pelz, T. Andersson, M. Soderman, P. Lylyk, and M. Negoro Advances in Interventional Neuroradiology 2005 Stroke, February 1, 2006; 37(2): 309 - 311. [Full Text] [PDF]