Abstract Details

Title Combined Intra-Arterial and Intra-Venous rt-PA Administration to Patients Selected Using SMART Criteria and CT Perfusion Is Safe and Effective

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P06 - (-)

Poster/Presentation
Number 258

Objective

Background BACKGROUND: Perfusion imaging may help select patients who would benefit from thrombolytic therapy. However few data are available demonstrating the routine use of CTP in patients receiving sequential full-dose IV and IA thrombolysis in combination with SMART criteria, which expand eligibility for IV rt-PA.

Design/Methods DESIGN/METHODS: Retrospective chart review (1/2008-2/2012) of patients who had CTP and received IV and IA rt-PA, with eligibility determined by SMART criteria. In this protocol, patients receive CTP/CTA prior to IA therapy, and proceed only if significant mismatch and treatable large artery occlusion are identified.

Results RESULTS: 38 patients were eligible; 35 had CTP mismatch. Median age was 65 (range 31-94). 94% received full dose IV rt-PA; 2 received half-dose IV tPA (fully anticoagulated with heparin or warfarin (n=1 each)). Mean IA rt-PA dose was 22.6 mg (range 3-52 mg). 74% received mechanical clot disruption via microcatheter/wire, angioplasty, MERCI (n=1), or PENUMBRA (n=3). Complete or partial revascularization was achieved in 94%. Mean times to IV and IA rt-PA were 112 minutes (45-266) and 385 minutes (184-887), respectively, with 49% receiving IA rt-PA > 6h from symptom onset. 7 (20%) died, 3 (8.6%) had symptomatic intracerebral hemorrhage (none were anticoagulated). Median NIHSS was 15.5 (SD 6.4) prior to IV rt-PA therapy and 8.5 (SD 16.1) at discharge. 7 (20%) patients had a discharge mRS ? 2.

Conclusions CONCLUSIONS: Selection of patients based on SMART criteria and CTP mismatch for sequential IV and IA rt-PA is safe, associated with a high recanalization rate, good outcome, and can extend thrombolysis treatment beyond conventional time windows. A controlled trial of this approach is warranted.

Authors/Disclosures
Ilana Spokoyny, MD (Sutter West Bay Medical Group) PRESENTER	Dr. Spokoyny has nothing to disclose.
nobl barazangi, MD, PhD	Dr. Barazangi has nothing to disclose.
Shirley Chen, DO (Memorial Regional Hospital)	No disclosure on file
Jack C. Rose, MD (Washington Township Medical Group)	No disclosure on file
	No disclosure on file
Charlene Chen, MD (Denali Therapeutics)	No disclosure on file
Christine S. Wong, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
David C. Tong, MD, FAHA	No disclosure on file

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