Section 3: Endovascular interventions through antiplatelet agents
- Intra-arterial tPA is actually not well studied. The evidence for intra-arterial thrombolysis is a couple trials with urokinase.
- Both the Solitaire and the Trevo, stent retrieval devices, outperformed Merci in head-to-head trials
- Immediate anticoagulation (like for NSTEMIs) hasn’t shown any net benefit
- Even the evidence of immediate aspirin is kind of weak: two trials individually had a non-significant effect on death/disability when started within 48 hours, but when combined, there was a modest effect, likely attributable to a reduction of early recurrent stroke
- Plavix takes at least 5 days for full effect when started at 75mg daily
- Aspirin comes in an IV formulation! But adding it to tPA worsened outcomes.