Acute Intraprocedural Thrombus Formation During Wingspan Intracranial Stent Placement for Intracranial Atherosclerotic Disease

2010 ◽  
Vol 67 (3) ◽  
pp. ons166-ons170 ◽  
Author(s):  
Matthew F. Lawson ◽  
Gregory L. Fautheree ◽  
Michael F. Waters ◽  
David A. Decker ◽  
J D. Mocco ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Balloon Angioplasty ◽  
Stent Placement ◽  
Thrombus Formation ◽  
Atherosclerotic Disease ◽  
Intracranial Atherosclerotic Disease ◽  
Arterial Tissue ◽  
Tissue Plasminogen

Abstract BACKGROUND: Treatment of intracranial atherosclerotic disease with the Wingspan-Gateway intracranial stent and balloon angioplasty system has been reported in several multicenter registries. To date, the incidence of acute intraprocedural thrombus formation during Wingspan stent placement has not been reported. OBJECTIVE: We reviewed the incidence of acute thrombus formation, treatment, and outcome for patients who underwent Wingspan stent placement by the senior author (B.L.H.) between June 2006 and April 2009. METHODS: We routinely perform angiograms every 10 minutes for at least 30 minutes after placement of a Wingspan stent to check for acute thrombus formation. Acute thrombus was graded: (1) visible thrombus but not flow limiting, (2) visible and flow-limiting thrombosis, and (3) complete stent occlusion. Recanalization was graded according to Thrombosis In Myocardial Infarction score. RESULTS: Forty-one patients underwent Wingspan stent placement for intracranial stenosis. Acute intraprocedural thrombus formation developed in 6 (14.6%) within 20 minutes after stent placement: 3 grade 1, 1 grade 2, and 2 grade 3. All 6 were successfully recanalized with Thrombosis In Myocardial Infarction score 3 after intravenous abciximab with or without intra-arterial tissue plasminogen activator and/or balloon angioplasty. There was no morbidity, and all 6 patients were discharged home at their neurological baseline. CONCLUSION: We recommend serial angiography every 10 minutes for at least 30 minutes after placement of Wingspan stents. Once detected, acute thrombosis can be successfully treated with intravenous abciximab with or without intra-arterial tissue plasminogen activator and/or balloon angioplasty.

scholarly journals Protective effects of leukopenia and tissue plasminogen activator in microvascular ischemia-reperfusion injury

2000 ◽  
Vol 278 (3) ◽  
pp. H755-H761 ◽  
Author(s):  
Silvia Bertuglia ◽  
Antonio Colantuoni
Keyword(s):  
Reperfusion Injury ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Ischemia Reperfusion Injury ◽  
Thrombus Formation ◽  
Ischemia Reperfusion ◽  
Low Flow ◽  
Cheek Pouch ◽  
Protective Effects ◽  
Tissue Plasminogen

Ischemia shifts the anticoaugulant/procoagulant balance of the endothelium in favor of activation of coagulation. We studied whether cheek pouch microcirculation of leukopenic hamsters was protected by tissue plasminogen activator (tPA) (50 μg/100 g body wt) against ischemia-reperfusion injury. Adherent leukocytes, total perfused capillary length (PCL), permeability increase, and arteriolar and venular red blood cell (RBC) velocity were investigated by fluorescence microscopy. Measurements were made at control, 30 or 60 min of ischemia, and at 30 or 60 min of reperfusion. Hamsters were made leukopenic by treatment with cyclophosphamide (20 mg/100 g body wt ip, 4 days before the experiment), which decreased circulating leukocyte count by 85–90%. Leukopenic hamsters undergoing 30 min of ischemia followed by 30 min of reperfusion showed no significant decrease in PCL or increased permeability. Leukopenic hamsters undergoing 60 min of ischemia followed by 60 min of reperfusion presented a significant decrease in microvascular perfusion where PCL was 28 ± 7% of baseline, low-flow conditions, and increased permeability. In leukopenic hamsters treated with tPA there was complete protection of capillary perfusion with no significant changes in permeability or arteriolar and venular RBC velocity. In conclusion, thrombus formation may be an additional and independent factor that with leukocyte-mediated mechanisms determines ischemia-reperfusion injury.

Pharmacokinetics of a Slower Clearing Tissue Plasminogen Activator Variant, TNK-tPA, in Patients with Acute Myocardial Infarction

1998 ◽  
Vol 79 (01) ◽  
pp. 134-139 ◽  
Author(s):  
Stephen Eppler ◽  
Judy Breed ◽  
Christopher Cannon ◽  
Eugene Braunwald ◽  
Ted Love ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Half Life ◽  
Plasma Clearance ◽  
Terminal Phase ◽  
Bolus Administration ◽  
Dose Escalation Study ◽  
Tissue Plasminogen

SummaryThe rapid clearance of t-PA from plasma requires administration by intravenous (IV) infusion. A slower clearing, fibrin-specific rt-PA variant may allow single intravenous bolus administration, thereby simplifying dosing. This study was designed to characterize the pharmacokinetics of the slower clearing, fibrin-specific tissue-plasminogen activator variant, TNK-tPA, in patients with acute myocardial infarction (AMI) following a single IV bolus injection. Single IV bolus doses of 5 to 50 mg of TNK-tPA were studied in an open-label, multicenter, dose escalation study. A total of 113 AMI patients were enrolled. Blood sampling for pharmacokinetics was conducted in eighty-two patients (72 men, 10 women), with 5 to 27 patients per dose. TNK-tPA was administered as an IV bolus over 5–10 s. Following IV bolus administration, there was a biphasic elimination of TNK-tPA from plasma. The initial phase had a mean half-life that ranged from 11 ± 5 to 20 ± 6 min and was followed by a terminal phase with a mean half-life that ranged from 41 ± 16 to 138 ± 84 min. Mean TNK-tPA plasma clearance was 125 ± 25 - 216 ± 98 ml/min, and the initial volume of distribution was 4.3 ± 2 - 8.4 ± 6 l. A decrease in TNK-tPA plasma clearance with increasing TNK-tPA dose was noted. In addition, women and patients with lower body weight or older age had a slower plasma clearance. In conclusion, TNK-tPA has a slower plasma clearance in patients with AMI than that reported for rt-PA, allowing administration as a single IV bolus.

Abstract 168: Outcomes of Intra-Arterial Tissue Plasminogen Activator Rescue Therapy During Stroke Thrombectomy-Insights From the STAR Collaboration

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Eyad Almallouhi ◽  
Sami Al kasab ◽  
Ali Alawieh ◽  
Reda M Chalhoub ◽  
Mohammad Anadani ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Adjunctive Treatment ◽  
Control Group ◽  
Arterial Tissue ◽  
Tissue Plasminogen

Introduction: Intra-arterial tissue plasminogen activator (IA-tPA) can be used as rescue therapy during mechanical thrombectomy for stroke patients, mostly in the setting of distal occlusion. The outcomes of IA-tPA has not been assessed in large-scale multi-center studies yet. Methods: We used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which included prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe, and Asia. We compared the baseline characteristics, procedural metrics, rate of symptomatic intracranial hemorrhage (sICH), and long-term functional outcomes between thrombectomy patients who received rescue IA-tPA and a control group of thrombectomy patients with matched age, National Institute of Health stroke scale (NIHSS) on presentation, location of occlusion and IV-tPA receipt. Results: A total of 2827 thrombectomy patients were included in the STAR registry. Out of those, 205 patients received IA-tPA. We matched 191 patients from the IA-tPA group with a control group of 191 patients (table 1). No difference was seen in age, sex, race, vascular risk factors, or Alberta Stroke Program Early CT (ASPECT) score between both groups. In addition, procedural metrics, including onset to groin time, the procedure duration, and rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score≥2b) were similar. Finally, similar outcomes were noted in both groups, including the rate of sICH and good 90-day functional outcome (modified Rankin scale≤2). Conclusion: The use of IA-tPA as an adjunctive treatment to mechanical thrombectomy was safe but did not result in a higher rate of successful recanalization or good long-term functional outcomes.

Distant haemorrhagic effects in intra-arterial Tissue Plasminogen Activator The effect of a bolus dose

1994 ◽  
Vol 80 (2) ◽  
pp. 66-70
Author(s):  
N P J Cripps ◽  
A S Ward
Keyword(s):  
Continuous Infusion ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Bolus Dose ◽  
Entry Site ◽  
Arterial Tissue ◽  
Tissue Plasminogen ◽  
Peripheral Arterial ◽  
Haemorrhage Rate ◽  
Arterial Thrombolysis

AbstractDetails are reported of four patients who developed serious distant haemorrhagic complications while undergoing peripheral arterial thrombolysis with intra-arterial tissue plasminogen activator (t-PA). The thrombolytic regime comprised a 20 mg bolus of t-PA followed by a continuous infusion of 1 mg/hr. Four additional cases of haemorrhage at the catheter entry site were also encountered in a group of 23 patients exposed to the bolus-infusion t-PA regimen. The high haemorrhage rate (31 % ) is a significant disadvantage of this thrombolytic protocol.

scholarly journals Coronary aspiration thrombectomy after using intravenous recombinant tissue plasminogen activator in a patient with acute ischemic stroke: a case report

2019 ◽  
Vol 47 (9) ◽  
pp. 4551-4556 ◽  
Author(s):  
Ton Mai Duy ◽  
Phuong DaoViet ◽  
Dung Nguyen Tien ◽  
Quang-Anh Nguyen ◽  
Thien Nguyen Tat ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Low Dose ◽  
Recombinant Tissue Plasminogen Activator ◽  
Aspiration Thrombectomy ◽  
Tissue Plasminogen ◽  
New Strategy

The complication of myocardial infarction after using intravenous recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke is rare. Several of these cases have been reported in the first 3 hours after infusion of rt-PA. There is controversy on how to manage treatment of the coronary artery, such as intravenous anticoagulants and antiplatelets, at the same time. We introduce a new strategy for treatment of a patient who had ischemic stroke and developed myocardial infarction after intravenous rt-PA therapy. Our case had coronary and cerebral intervention in combination with low-dose intravenous rt-PA. He was successfully treated for coronary occlusion with aspiration thrombectomy.

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