Interesting because an occlusion of the carotid artery does not directly cause a stroke if the Circle of Willis is complete. So I don't understand.
Utility of tPA Administration in Acute Treatment of Internal Carotid Artery Occlusions
Abstract
Background
Intravenous
tissue plasminogen activator (IV-tPA) remains part of the guidelines
for acute ischemic stroke treatment, yet internal carotid artery
occlusions (ICAO) are known to be poorly responsive to IV-tPA. It is
unknown whether bridging thrombolysis (BT) is beneficial in such cases.
Purpose
We
sought to evaluate whether the use of IV-tPA improved overall clinical
outcomes in patients undergoing endovascular thrombectomy (EVT) for ICA
occlusions.
Methods
Data
from 1367 consecutive stroke cases treated with EVT from 2012-2019 were
prospectively collected from a single center. Univariate and
multivariate logistic regression were used to assess the relationship
between IV-tPA administration and clinical outcome.
Results
153
patients were found to have carotid terminus and tandem ICAO who
received EVT and presented within 4.5h of last seen well. 50% (n = 82)
received IV tPA. There were no differences between the groups with
respect to age, NIHSS, time to EVT and ASPECTS score. 53% had tandem
ICA-MCA occlusions. Rate of recanalization (≥ TICI 2B) and sICH did not
significantly differ between the two groups. Regression analysis
demonstrated no effect of IV-tPA on modified Rankin Score (mRS) at 90
days and overall mortality. Factors significantly associated with
reduced mortality included lower age, lower NIHSS, and better rate of
recanalization.
Conclusions
There
was no significant difference in clinical outcomes in those receiving
BT vs. direct EVT for ICAO. For centers with optimal door-to-puncture
times, bypassing IV-tPA may expedite recanalization times and
potentially yield more favorable outcomes. Patients with higher NIHSS
and tandem lesions may have better outcomes with BT.
