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I know this may sound stupid, but how does IV tPA work on an arterial ischemic stroke? wouldn't intrarterial tPA be better?
tPA question
- Thread starter DOstudent22
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IV still becomes systemic and is able to help with the clot. This basic pathway:
You would think intra-arterial tPA would be better, but the most recent evidence points out that it isn't: http://www.ims3.org/. Hopefully some further sub-group data analysis will help answer some questions regarding which strokes/groups of patients would benefit from interventional stroke management (intra-arterial tPa, mechanical...etc.).
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IV tPA for stroke works the same way that IV tPA works (at least to some degree) for STEMI. The half life of tPA is short, on the order of minutes, but the fibrinogen depletion (and coagulopathy) that occurs as a result lasts many hours. So even by administering IV, it still works systemically.
IA tPA must be delivered from a proximate source, so the only way to do it is via catheter-based intervention at the level of the occlusion. We certainly do this, but it is clearly a more invasive intervention than IV tPA. As previously noted, we are not clear currently on how to identify the best patients for such therapeutics, and so IV tPA remains the therapy of choice, aside from clinical trial enrollment at some centers (DIAS-4, MR-RESCUE, etc.)
We are all sort of on hold until the IMS-3 results are formally announced.
IA tPA must be delivered from a proximate source, so the only way to do it is via catheter-based intervention at the level of the occlusion. We certainly do this, but it is clearly a more invasive intervention than IV tPA. As previously noted, we are not clear currently on how to identify the best patients for such therapeutics, and so IV tPA remains the therapy of choice, aside from clinical trial enrollment at some centers (DIAS-4, MR-RESCUE, etc.)
We are all sort of on hold until the IMS-3 results are formally announced.
