Combined intravenous and intra-arterial infusion of recombinant tissue plasminogen activator for treatment of acute ischemic stroke

Objective To investigate the clinical efficacy and safety of combined intravenous and intra-arterial infusion of recombinant tissue plasminogen activator(rt-PA) for treatment of acute ischemic stroke.Methods A total of 106 patients with acute ischemic stroke within 6 hours after the onset of symptoms were randomly assigned into a superselective intravenous and intra-arterial thrombolysis group(combined group,n=60) and a superselective intra-arterial thrombolysis group(intra-arterial group,n=46).Microcatheter were used superselectively to reach the affected arteries,and 50 mg rt-PA was injected in the intra-arterial group.A total of 50 mg rt-PA was dripped intravenously first,then followed by the intra-arterial infusion in the combined group.The neurological deficit was assessed with the European Stroke Scale(ESS) before thrombolysis and 6,24 hours,7 and 30 days after thrombolysis.Results The ESS scores were 42±13 and 43±10 respectively in the combined and intra-arterial groups;the ESS scores were 82±23 and 89±25 respectively at 24 hours and 30 days after the treatment in the combined group,and they were 76±27 and 82±23 respectively in the intra-arterial group.The total recanalization rates were 53%(32/60) and 35%(16/46) respectively in the combined and intra-arterial groups.There were significant differences between the two groups(P0.05).The incidence of intracranial hemorrhage was 7%(4/60) and 9%(4/46) respectively in the combined and intra-arterial groups,and there were no significant differences between them.Conclusion Combined intravenous and intra-arterial thrombolysis is a relatively safe and effective therapeutic approach within 6 hours after the onset of cerebral infarction.