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. 2023 Jan;13(1):40-45.
doi: 10.1177/19418744221123610. Epub 2022 Oct 9.

Utility of tPA Administration in Acute Treatment of Internal Carotid Artery Occlusions

Kavit Shah  1 , Keiko A Fukuda  2 , Shashvat M Desai  3 , Bradley A Gross  4 , Ashutosh P Jadhav  5
Affiliations

Utility of tPA Administration in Acute Treatment of Internal Carotid Artery Occlusions

Kavit Shah et al. Neurohospitalist. 2023 Jan.

Abstract

Background: Intravenous tissue plasminogen activator (IV-tPA) remains part of the guidelines for acute ischemic stroke treatment, yet internal carotid artery occlusions (ICAO) are known to be poorly responsive to IV-tPA. It is unknown whether bridging thrombolysis (BT) is beneficial in such cases.

Purpose: We sought to evaluate whether the use of IV-tPA improved overall clinical outcomes in patients undergoing endovascular thrombectomy (EVT) for ICA occlusions.

Methods: Data from 1367 consecutive stroke cases treated with EVT from 2012-2019 were prospectively collected from a single center. Univariate and multivariate logistic regression were used to assess the relationship between IV-tPA administration and clinical outcome.

Results: 153 patients were found to have carotid terminus and tandem ICAO who received EVT and presented within 4.5h of last seen well. 50% (n = 82) received IV tPA. There were no differences between the groups with respect to age, NIHSS, time to EVT and ASPECTS score. 53% had tandem ICA-MCA occlusions. Rate of recanalization (≥ TICI 2B) and sICH did not significantly differ between the two groups. Regression analysis demonstrated no effect of IV-tPA on modified Rankin Score (mRS) at 90 days and overall mortality. Factors significantly associated with reduced mortality included lower age, lower NIHSS, and better rate of recanalization.

Conclusions: There was no significant difference in clinical outcomes in those receiving BT vs. direct EVT for ICAO. For centers with optimal door-to-puncture times, bypassing IV-tPA may expedite recanalization times and potentially yield more favorable outcomes. Patients with higher NIHSS and tandem lesions may have better outcomes with BT.

Keywords: acute ischemic stroke; carotid occlusion; thrombectomy; thrombolysis.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Gross: consultant for Medtronic and Microvention

Figures

Figure 1.
Figure 1.
Reasons for not receiving IV tPA
See this image and copyright information in PMC

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