Percutaneous Intra Arterial Thrombolysis on Peri-coronary Angiography Ischemic Stroke: Initial Experience in National Cardiac Center Harapan Kita
AbstractBackground. Ischemic stroke is a rare but well-known complication of cardiac-catheter interventions attributable mostly to embolism. Peri-coronary angiography stroke, represents a unique opportunity for im-mediate stroke interventional therapy with intravenous, catheter based intra-arterial thrombolysis (IAT) or combined therapy using recombinant tissue plasminogen activator (rtPA). Intra-arterial thrombolysis is an option for treatment of selected patients who have major stroke of < 6 hours duration due to occlusion of the Media Cerebral artery(MCA) and who are not otherwise candidates for intravenous rtPA (Class I, Level of Evidence B, AHA guidelines).
Objective.To review the first experience of percutaneous intra-arterial thrombolysis(PIAT) as a management of acute ischemic stroke due to complication of coronary angiography procedure.
Summary. We present 3 cases of acute ischemic stroke which happened during coronary angiography procedures. All of them (NIHSS 30, 20 and 34) were treated immediately with intra-arterial thrombolysis (IAT) recom-binant tissue Plasminogen Activator (rtPA) and had a very good outcome with no residual of stroke (NIHSS 0). Although it has been stated clearly in the AHA guidelines for the early management of adult with ischemic stroke, up until now the procedure of IAT or (intra-venous thrombolysis) IVT upon acute ischemic stroke is not established yet in standard operational procedure of National Cardiovascular Center Harapan Kita (NCCHK) Jakarta, which perhaps makes the physicians hesitate on performing these procedures due to legal aspects, while in the other hand the risks of acute ischemic stroke remain the potential threats on every single coronary angiography or any intensive catheter based procedures.
Zaidat OO, Slivka AP, Mohammad Y, Graffagnino C, Smith TP, Enterline DS, Christoforidis GA, Alexander MJ, Landis DM, Suarez JI. Intra-arterial thrombolytic therapy in peri-coronary angiography ischemic stroke. Stroke. 2005;36:1083-1084.
Zaidat OO, Suarez JI, Santillan C, Sunshine JL, Tarr RW, Paras V?, Selman WR, Landis DM. Intra-arterial and combined intravenous and intra-arterial thrombolytic therapy for distal carotid artery occlusion. Stroke. 2002;33:1828-1833.
Data of medical record of the National Cardiovascular Center Harapan Kita Jakarta (unpublished)
Hallevi H, Barreto AD, Liebeskind DS, Morales MM, Martin-Schild SB, Abraham AT, Gadia J, Saver JL; UCLA Intra-Arterial Therapy Investigators, Grotta JC, Savitz SI. Identifying patients at high risk for poor outcome after intra-arterial therapy for acute ischemic stroke. Stroke. 2009;40:1780-1785.
Bose A, ?enkes ?, Alfke K, Reith W, Mayer TE, Berlis A, Branca V, Sit SP; Penumbra Phase 1 Stroke Trial Investigators. The penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol. 2008;29: 1409-1413.
Ciccone A, Valvassori L, Ponzio M, Ballabio E, Gasparotti R, Sessa M. Intra-arterial or intravenous thrombolysis for acute ischemic stroke? The SYNT?ESIS pilot trial. J NeuroIntervent Surg 2010;2:74-79.
Guidelines for the early management of adults with ischemic stroke. Circulation. 2007;115:e478-e534.
Ueda T, Sakaki S, Nochide I, Kumon Y, Kohno K, Ohta S. Angioplasty after intra-arterial thrombolysis for acute occlusion of intracranial artery. Stroke. 1998;29:2568-2574.
Arnold M, Fischer U, Schroth G, Nedeltchev K, Isenegger J, Re-monda L, Windecker S, Brekenfeld C, Mattle ?P. Intra-arterial thrombolysis of acute iatrogenic intracranial arterial occlusion attributable to neuroendovascular procedures or coronary an-giography. Stroke. 2008;39:1491-1495.
Roberts ?C, Dillon WP, Furlan AJ, Wechsler LR, Rowley ?A, Fischbein NJ, ?igashida RT, Kase C, Schulz GA, Lu Y, Firszt CM. Computed tomographic findings in patients undergoing intra-arterial thrombolysis for acute ischemic stroke due to middle cerebral artery occlusion. Stroke. 2002;33:1557-1567.
Gönner F, Remonda L, Mattle ?, Sturzenegger M, Ozdoba C, Lövblad KO, Baumgartner R, Bassetti C, Schroth G. Local intra-arterial thrombolysis in acute ischemic stroke. Stroke. 1998;29:1894-1900.
Furlan A, ?igashida R, Wechsler L, Gent M, Rowley ?, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. JAMA. 1999;282:2003-2011.
Brekenfeld C, Remonda L, Nedeltchev K, Arnold M, Mattle HP, Fischer U, Kappeler L, Schroth G. Symptomatic intracranial haemorrhage after intra-arterial thrombolysis in acute ischaemic stroke: assessment of 294 patients treated with urokinase. J Neurol Neurosurg Psychiatry. 2007;78:280-285.
PDF downloads: 414
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).