OBJECTIVE: We prospectively evaluated the safety and recanalization efficacy of intra-arterially administered reteplase, a third-generation recombinant tissue plasminogen activator, for treating @entity385 in @entity1 considered poor candidates for intravenously administered alteplase therapy. METHODS: @entity1 were considered poor candidates for intravenously administered therapy because of severity of @entity51 , interval from onset of symptoms to presentation of 3 hours or more, or recent major surgery. We administered a maximum total dose of 8 U of reteplase intra-arterially in 1-U increments via superselective catheterization. Adjunctive angioplasty of the occluded artery was performed in seven @entity1 . Angiographic evidence of perfusion and @entity715 was graded by use of modified Thrombolysis in @entity583 (TIMI) criteria. Neurological examinations were performed before and 24 hours and 7 to 10 days after treatment. RESULTS: Sixteen consecutive @entity1 were treated (mean age, 64.1 +/- 16.4 yr; seven were @entity1 ). Initial National Institutes of Health Stroke Scale scores ranged from 10 to 26. Time from onset of symptoms to treatment ranged from 2 to 9 hours. Occlusion sites were the cervical internal carotid artery (n = 4), intracranial internal carotid artery (n = 4), middle cerebral artery (n = 6), and vertebrobasilar artery (n = 2). Complete or near-complete perfusion (TIMI Grade 3 or 4) was achieved in the arteries in 14 @entity1 (88%), with partial recanalization (TIMI Grade 2) or minimal response (TIMI Grade 1) in the arteries in one @entity1 each. @entity16 (defined as decrease of four or more points in National Institutes of Health Stroke Scale score) was observed in 7 (44%) of the 16 @entity1 at 24 hours. Symptomatic @entity1779 occurred in one @entity1 ; three other @entity1 experienced @entity1779 that did not result in neurological worsening. The overall mortality during hospitalization was 56%, related to massive @entity385 (n = 7), withdrawal of care at the family's request after the development of @entity1174 and @entity177 (n = 1), and a combination of @entity1779 and massive @entity385 (n = 1). CONCLUSION: In this study, intra-arterially administered reteplase in doses up to 8 U with or without angioplasty resulted in a high rate of recanalization. This strategy should be considered in treating @entity1 considered poor candidates for intravenous thrombolysis.

Intra-arterial third-generation recombinant tissue plasminogen activator (reteplase) for acute XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'men'] @entity16 :: ('MESH:D009422', 'Disease') :: ['Neurological improvement'] @entity177 :: ('MESH:D051437', 'Disease') :: ['renal failure'] @entity51 :: ('MESH:D009461', 'Disease') :: ['neurological deficits'] @entity1174 :: ('MESH:D011015', 'Disease') :: ['aspiration pneumonia'] @entity1779 :: ('MESH:D002543', 'Disease') :: ['intracerebral hemorrhages', 'intracerebral hemorrhage'] @entity583 :: ('MESH:D009203', 'Disease') :: ['Myocardial Infarction'] @entity715 :: ('MESH:D013927', 'Disease') :: ['thrombus'] @entity385 :: ('MESH:D002544', 'Disease') :: ['ischemic stroke']
@entity385 :: (MESH:D002544,Disease) :: ['ischemic stroke']
