Hong Kong Med J 2013;19:135–41 | Number 2, April 2013
Intra-arterial revascularisation therapy for acute ischaemic stroke: initial experience in a Hong Kong hospital
Edward HC Wong, Simon CH Yu, Alexander YL Lau, Venus SW Hui, Cecilia SF Leung, Joyce WY Hui, Deyond YW Siu, Jill M Abrigo, KT Lee, Colin A Graham, Lawrence KS Wong, Thomas WH Leung
Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
OBJECTIVES. To assess the outcome of acute ischaemic stroke patients who received intra-arterial therapy in our unit.
DESIGN. Case series.
SETTING. A tertiary hospital in Hong Kong.
PATIENTS. Patients with ischaemic stroke due to large artery occlusion treated within 6 hours from symptom onset between January 2007 and May 2011.
INTERVENTION. Acute intra-arterial revascularisation therapy.
MAIN OUTCOME MEASURES. Primary outcome was functional independence (modified Rankin Scale score of ≤2) at 3 months. Secondary outcome was rate of recanalisation. Safety outcomes were symptomatic intracranial haemorrhage and 3-month mortality.
RESULTS. Twenty-one patients with a mean age of 67 years fulfilled the inclusion criteria. Their mean National Institutes of Health Stroke Scale score was 18. The mean onset-to-puncture time was 212 minutes. Nine received intra-arterial tissue plasminogen activator alone, 11 had an adjunctive mechanical thrombectomy, and one received balloon angioplasty without tissue plasminogen activator. At the end of the procedure, thrombolysis grade 2a or better was attained in 18 (86%) of the patients, and 8 (38%) achieved functional independence at 3 months. Rates of symptomatic intracranial haemorrhage and 3-month mortality were 10% and 24%, respectively.
CONCLUSION. In this setting, intra-arterial revascularisation therapy appeared safe and efficacious for this selected group of ischaemic stroke patients with large artery occlusions. Experience gained from this pilot study may help improve clinical outcomes of such patients.
Key words: Brain ischemia; Magnetic resonance angiography; Stroke; Tissue plasminogen activator; Treatment outcome
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