BACKGROUND: Intravenous alteplase for acute @entity385 is least efficacious for @entity1 with @entity432 and clinically severe @entity64 . Intra-arterial therapy has the theoretical advantage of establishing a neurovascular diagnosis and high symptomatic artery patency rate but the disadvantage of requiring extra time and technical expertise. A combination of these two approaches may provide the best chance of improving outcome in severe acute @entity385 . We sought to assess the safety and feasibility of this approach. METHODS: This was a prospective, open-label study. Sequential @entity1 arriving to our center within 3 hours of @entity64 onset who were treated with intravenous alteplase were screened for possible additional intra-arterial therapy using noninvasive neuroimaging. Clinical measures and outcomes were recorded prospectively. RESULTS: A total of 861 @entity1 with @entity385 were admitted to Calgary hospitals during the study period. Eight @entity1 over 21 months underwent a combined intravenous-intra-arterial approach. Six received intra-arterial alteplase and 1 underwent intracranial angioplasty; in a final @entity1 , technical aspects prevented intra-arterial therapy. Early neurovascular and/or neurometabolic imaging identified the location of occlusion and tissue-at-risk (DWI-PWI mismatch) in all 8 @entity1 . Two @entity1 had a poor outcome, 1 @entity1 suffered a significant groin @entity1410 , and there were no instances of symptomatic @entity1779 . CONCLUSIONS: Intravenous followed by intra-arterial therapy is a promising approach to the treatment of severe acute @entity385 . Early noninvasive neurovascular and neurometabolic imaging is very helpful in choosing candidates for this type of therapy. On-going monitoring of alteplase-treated @entity1 may allow the opportunity to perform rescue intra-arterial therapy.

Acute intravenous--intra-arterial revascularization therapy for severe XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes', 'stroke'] @entity1410 :: ('MESH:D006406', 'Disease') :: ['hematoma'] @entity432 :: ('MESH:D001157', 'Disease') :: ['proximal large-artery occlusions'] @entity1779 :: ('MESH:D002543', 'Disease') :: ['intracerebral hemorrhage'] @entity385 :: ('MESH:D002544', 'Disease') :: ['ischemic stroke']
@entity385 :: (MESH:D002544,Disease) :: ['ischemic stroke']
