What is intra-arterial (intra arterial) therapy?

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DS

Dainyal Siddiqui, MD

Internal Medicine

MJ

Manuel Jimenez, MD

Cardiology

FP

Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 2, 2025 • View editorial policy

From the Guidelines

Intra-arterial thrombolysis is a beneficial treatment option for carefully selected patients with acute ischemic stroke secondary to occlusion of the middle cerebral artery (MCA), as it allows for targeted delivery of thrombolytic agents directly into the cerebral circulation. This approach has been shown to be effective in recanalizing occluded cerebral arteries and improving clinical outcomes in patients with acute ischemic stroke 1. The use of intra-arterial thrombolysis is typically considered when patients miss the therapeutic window for intravenous thrombolysis or have contraindications to intravenous thrombolysis.

Key Considerations

  • Intra-arterial thrombolysis is a complex procedure that requires careful patient selection and expertise in interventional neuroradiology or neurology 2.
  • The procedure involves catheter insertion through a peripheral artery and navigation to the target vessel using fluoroscopic guidance.
  • The main advantage of intra-arterial administration is targeted delivery, allowing higher concentrations of medications or contrast agents to reach specific organs or tissues while minimizing systemic exposure and side effects.

Clinical Evidence

  • A prospective, randomized, placebo-controlled phase III study demonstrated that intra-arterial thrombolysis with recombinant prourokinase was effective in recanalizing occluded MCA and improving clinical outcomes in patients with acute ischemic stroke 1.
  • Other studies have shown that intra-arterial urokinase may be beneficial in patients with vertebral or basilar artery occlusion treated within 24 hours of symptom onset and patients with embolic stroke involving the anterior circulation within 4.5 hours of symptom onset 3.

Recommendations

  • Intra-arterial thrombolysis should be considered as a treatment option for carefully selected patients with acute ischemic stroke secondary to occlusion of the MCA.
  • Patients who are evaluated within 6 hours of symptoms but who are ineligible to receive intravenous thrombolysis because of recent surgery or other procedures may be candidates for intra-arterial thrombolysis.
  • New criteria have been established to determine the qualifications of physicians who can perform intra-arterial thrombolysis on the basis of recent statements from professional organizations and clinical trials 2.

From the FDA Drug Label

Peripheral neurotoxicity in the form of local-regional sensory and/or motor disturbances have been reported in patients treated intra-arterially with doxorubicin, mostly in combination with cisplatin. Animal studies have demonstrated seizures and coma in rodents and dogs treated with intra-carotid doxorubicin Seizures and coma have been reported in patients treated with doxorubicin in combination with cisplatin or vincristine.

The use of doxorubicin intra-arterially may cause peripheral neurotoxicity, including local-regional sensory and/or motor disturbances, and has been associated with seizures and coma in some cases, particularly when used in combination with other drugs like cisplatin or vincristine 4.

From the Research

Intra-Arterial Therapy in Acute Ischemic Stroke

  • Intra-arterial (IA) treatment is effective for emergency revascularization of proximal intracranial arterial occlusions 5
  • IA therapy has been shown to be at least as effective as intravenous thrombolysis in acute ischemic stroke 6
  • The use of IA thrombolysis in acute ischemic stroke has evolved, with fewer than 200 patients enrolled in randomized trials 7

Comparison of Intra-Arterial Thrombolysis and Mechanical Interventions

  • Mechanical thrombectomy has been shown to have higher recanalization rates and improved functional outcomes compared to IA thrombolysis in patients with intracranial internal carotid artery occlusion 8
  • Stenting has been shown to have higher recanalization rates and improved functional outcomes compared to IA thrombolysis in patients with extracranial internal carotid artery occlusion 8

Safety and Efficacy of Intra-Arterial Therapy

  • The risk of hemorrhage associated with IA therapy may be low, with one study reporting a 14% rate of asymptomatic intracerebral hemorrhage 9
  • IA therapy has been shown to be safe and effective in achieving recanalization, with complete or partial recanalization achieved in 17 of 21 patients in one study 9

Adjunctive Therapy with Platelet Glycoprotein IIb/IIIa Inhibitors

  • The use of platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy to IA thrombolysis has been shown to be safe and effective in achieving recanalization 9
  • The combination of IA thrombolysis and mechanical interventions, including balloon angioplasty, has been shown to be effective in achieving recanalization and improving clinical outcomes 9

References

6
Research

Intra-arterial thrombolysis in acute stroke.

Current opinion in neurology, 2000

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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