Efficacy of Intra-Arterial vs. Intravenous tPA Monotherapy in Acute Ischemic Stroke Treatment

Authors : Emrah Keskin, Gökhan Özdemir, Mehmetselim Gel

Pages : 98-106

View : 17 | Download : 32

Publication Date : 2025-04-30

Article Type : Research Paper

Abstract :Aim: The method and timing of administration of tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke (AIS) remain unclear. In our study, we aimed to compare the effectiveness of intra-arterial (IA)-tPA compared to intra-venous (IV)-tPA in AIS. Material and Methods: Patients with AIS received IV-tPA within one hundred and eight minutes or IA-tPA within the first six hours. Before both treatments, their conditions were evaluated and treatments were performed. AIS patients were divided into those receiving IV alteplase (maximum 0.90 mg/kg) and those receiving IA alteplase (maximum 0.30 mg/kg). Demographic characteristics, systemic diseases and clinical outcomes were evaluated in both groups. Results: It was observed that the clinical findings of the patients in the IA group were worse at the time of admission, but were better than those in the IV group after the procedure. While the ICH rate was similar in both groups (p>0.817); the recanalization rate was higher in the IA group compared to the IV group (p<0.001). Patients receiving IA treatment with alteplase doses of 20 mg or less had better clinical improvement (p = 0.020). In the IA group, the relationship between recanalization rate and the time of the onset of early treatment was statistically significant (p = 0.007). Conclusion: According to the findings of our study, IA administration of tPA in the treatment of AIS is a more effective and applicable treatment option than IV administration. In addition, since higher recanalization rates and better clinical outcomes are observed in patients who receive IA-tPA treatment in the early period, more effective results can be obtained, especially in patients with large vessel occlusion.
Keywords : akut iskemik inme, tPA, intra-arteriyel, intra-venöz