BACKGROUND AND PURPOSE: The purpose of this study was to evaluate preliminarily the efficacy and safety of intravenous tirofiban combined with intra-arterial pharmacologic and mechanical thrombolysis in patients with stroke. METHODS: Twenty-one consecutive patients with an acute ischemic stroke due to major cerebral arteries occlusion and a National Institutes of Health Stroke Scale [NIHSS] score > or = 18 were treated with an intravenous bolus of tirofiban and heparin followed by intra-arterial administration of urokinase coupled with mechanical thrombolysis. RESULTS: Thirteen patients had an anterior circulation stroke (T-siphon internal carotid artery [ICA] = 7; middle cerebral artery [MCA] = 6), 6 patients a posterior circulation stroke, and 2 patients an anterior plus posterior circulation stroke (left ICA or M1 tract of MCA plus basilar artery occlusions). Mean NIHSS score on admission was 21 (range, 18-27). Immediate recanalization was successful (thrombolysis in myocardial infarction [TIMI] 2-3) in 17 of 21 patients. The following day, 14 of 19 patients improved substantially and complete vessel patency (TIMI 3-4) was confirmed by digital subtraction angiography. Intracranial bleeding occurred in 5 of 21 patients (3 symptomatic cerebral hemorrhages and 2 subarachnoid hemorrhages) and was fatal in the case of 3 patients. At discharge, the mean NIHSS was 5.4 (range, 0-25). Overall, at 3-month follow-up the functional outcome was favorable (modified Rankin Scale score = 0-2) in 13 of 21 (62%) patients. Death (including all causes) at 90 days occurred in 6 of 21 (28%) cases. CONCLUSIONS: The combination of intravenous tirofiban with intra-arterial urokinase and mechanical thrombolysis may be successful in reestablishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions.
BACKGROUND AND PURPOSE: The purpose of this study was to evaluate preliminarily the efficacy and safety of intravenous tirofiban combined with intra-arterial pharmacologic and mechanical thrombolysis in patients with stroke. METHODS: Twenty-one consecutive patients with an acute ischemic stroke due to major cerebral arteries occlusion and a National Institutes of Health Stroke Scale [NIHSS] score > or = 18 were treated with an intravenous bolus of tirofiban and heparin followed by intra-arterial administration of urokinase coupled with mechanical thrombolysis. RESULTS: Thirteen patients had an anterior circulation stroke (T-siphon internal carotid artery [ICA] = 7; middle cerebral artery [MCA] = 6), 6 patients a posterior circulation stroke, and 2 patients an anterior plus posterior circulation stroke (left ICA or M1 tract of MCA plus basilar artery occlusions). Mean NIHSS score on admission was 21 (range, 18-27). Immediate recanalization was successful (thrombolysis in myocardial infarction [TIMI] 2-3) in 17 of 21 patients. The following day, 14 of 19 patients improved substantially and complete vessel patency (TIMI 3-4) was confirmed by digital subtraction angiography. Intracranial bleeding occurred in 5 of 21 patients (3 symptomatic cerebral hemorrhages and 2 subarachnoid hemorrhages) and was fatal in the case of 3 patients. At discharge, the mean NIHSS was 5.4 (range, 0-25). Overall, at 3-month follow-up the functional outcome was favorable (modified Rankin Scale score = 0-2) in 13 of 21 (62%) patients. Death (including all causes) at 90 days occurred in 6 of 21 (28%) cases. CONCLUSIONS: The combination of intravenous tirofiban with intra-arterial urokinase and mechanical thrombolysis may be successful in reestablishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions.
Authors: K Fassbender; C E Dempfle; O Mielke; A Schwartz; M Daffertshofer; C Eschenfelder; M Dollman; M Hennerici Journal: Stroke Date: 1999-10 Impact factor: 7.914
Authors: Adnan I Qureshi; Mustafa Saad; Osama O Zaidat; Jose I Suarez; Michael J Alexander; M Fareed; K Suri; Zulfiqar Ali; L Nelson Hopkins Journal: Stroke Date: 2002-07 Impact factor: 7.914
Authors: Jens Fiehler; Michael Söderman; Francis Turjman; Philip M White; Søren Jacob Bakke; Salvatore Mangiafico; Rüdiger von Kummer; Mario Muto; Christophe Cognard; Jan Gralla Journal: Neuroradiology Date: 2012-09-05 Impact factor: 2.804
Authors: Zhong-Song Shi; David S Liebeskind; Yince Loh; Jeffrey L Saver; Sidney Starkman; Paul M Vespa; Nestor R Gonzalez; Satoshi Tateshima; Reza Jahan; Lei Feng; Chad Miller; Latisha K Ali; Bruce Ovbiagele; Doojin Kim; Gary R Duckwiler; Fernando Viñuela Journal: Stroke Date: 2010-11-04 Impact factor: 7.914
Authors: A Chiti; G Gialdini; E Terni; N Giannini; M Gennaro; G A Lazzarotti; M Puglioli; G Orlandi; U Bonuccelli Journal: Neurol Sci Date: 2013-05-24 Impact factor: 3.307