Individualized intravenous thrombolytic strategy for acute ischemic stroke with large vessel occlusion on the era of mec
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ORIGINAL ARTICLE
Individualized intravenous thrombolytic strategy for acute ischemic stroke with large vessel occlusion on the era of mechanical thrombectomy: cases report Pengfei Xing 1
&
Hongjian Shen 1 & Zifu Li 1 & Pengfei Yang 1 & Yongwei Zhang 1 & Jianmin Liu 1
Received: 9 August 2018 / Accepted: 9 October 2019 # The Author(s) 2019
Abstract Intravenous thrombolysis for acute ischemic stroke within 4.5 h after the onset of symptoms has become a standard therapy that is recommended by many trials and clinical guidelines. As on the era of mechanical thrombectomy for acute ischemic stroke with large vessel occlusions, whether intravenous thrombolysis (IVT) is still necessary, and how to choose the optimal dose are still controversy. Here, we reported two cases of acute ischemic stroke with large vessel occlusions that both achieved complete recanalization after IVT. Then, IVT was terminated in advance, and dynamic surveillance by DSA was performed to achieve individual treatment. However, both of the cases presented with hemorrhagic transformation. We analyzed the probable reasons and put forward thoughts from ourselves. Keywords Intravenous thrombolysis . Mechanical thrombectomy . Ischemic stroke
Introduction Intravenous thrombolysis (IVT) for acute ischemic stroke within 4.5 h after the onset of symptoms, using recombinant tissue-type plasminogen activator (rtPA) with the recommended dose of 0.9 mg/kg, is a standard therapy and recommended by various trials and guidelines [1–3]. However, the Pengfei Xing and Hongjian Shen contributed equally to this work. * Yongwei Zhang [email protected] * Jianmin Liu [email protected] Pengfei Xing [email protected] Hongjian Shen [email protected] Zifu Li [email protected] Pengfei Yang [email protected] 1
Department of Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, No.168 Changhai Rd, Shanghai 200433, China
appropriate dose is still being controversial considering the balance of effectiveness and safety. Some studies showed that low-dose rtPA was comparable with the standard-dose treatment in terms of effectiveness [4–7]. In contrast, someone indicated that standard-dose intravenous rtPA could achieve more favorable outcome without increasing the risk of symptomatic hemorrhage than low-dose rtPA [8]. Moreover, comparing with IVT, mechanical thrombectomy (MT) has been proved to be more effective for acute ischemic stroke with large vessel occlusion (AIS-LVO) due to the high rates of successful recanalization (modified TICI 2b–3 grades) [9–15]. The subgroup study of HERMES collaboration suggested that the effects favoring the intervention was significant in those not receiving intravenous alteplase [16]. Therefore, the major controversy is that whether it is necessary to perform IVT before MT for AIS-LVO within the thrombolytic time window. We reported two cases of AIS-LVO that was treated by only IVT, and the dose of intravenous rtPA was controlled individually according to their timely angiography results.
Case 1 A 67-year
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