JAMA Neurol: Efficacy of intraartial thrombosis as a remedy for thrombosis

Successful re-perfusion - ideal full re-perfusion (TICI 3) - is the most relevant and modifiable determinant of functional prognosis in patients with large vascular lysate acute ischemic stroke (mechanical thrombetomy, MT)However, almost one in ten patients did not reach re-injection, and most successfully treated patients did not reach TICI 3, according to herMES collaboration and large-scale registration studiesTherefore, in the event of surgical failure or for the achievement of full re-perfusion (TICI 3) rather than near total re-perfusion (TICI 2b), finding alternative treatments after MT may improve the patient's prognosisgiven thrombosis in the arteries, such as tissue lysozyme progenitor activator (tPA) or urinary kinase, select one of which may be a promising treatment optionHowever, as a second-generation MT device-assisted treatment, data on the safety and efficacy of arterial thrombosis are scarcepublished their findings in JAMA Neurology in March 2020 by Johannes Kaesmacher of Switzerland and others to explore the efficacy of urinary kinase in the arterial after MT treatment failure or incomplete re-infusionincluded in this retrospective cohort study a continuous period of patients from January 2010 to April 2017 who underwent second-generation MT treatment, of which 993 met the criteria for precirculation of large vascular clotting and 100 patients who were injected with urinary kinase in a manual microcatheter artery after MT failure or incomplete MTThe main safety endpoint is sICH (Prolyse in Acute Cerebral Thrombolism II criteria), with a secondary endpoint of 90-day mortality and 90-day functional independence (mRS s2)Evaluation of effectiveness by angiography (TICI rating)the average age ofwas 74.6 yearsThe most common cause of using urinary kinase is MT-post remutage (TICI 3), which accounts for 53%After adjusting the baseline characteristics, the arterial intraartial urinary kinase was not associated with an increase in sICH (aOR, 0.81; 95% CI, 0.31-2.13) or 90-day mortality (aOR, 0.78; 95% CI, 0.43-1.40)In 53 patients with partially repertoire and urinary kinase use in arteries, 60.4% achieved an early reperfusion improvement and 34% achieved an improvement in TICI gradingAccordingly, after adjusting the selection bias (which facilitates poor TICI grading of the intraartial urinary kinase group), the functional independence rate is higher in patients using urinary kinase in the arteries (aOR, 1.93; 95% CI, 1.11-3.37)the final authors concluded that for screened patients, the safety of urinary kinases given during MT or in the post-MT arteries could improve the re-infusion of angiography This method is systematically evaluated in randomized clinical trials after a multicenter prospective registration study