Intracarotid urokinase with thromboembolic occlusion of the middle cerebral artery.

Abstract

Intracarotid urokinase infusion therapy was performed on 22 patients with evolving cerebral infarction due to acute thromboembolic occlusion of the middle cerebral artery. Mean time from onset of symptoms to start of infusion and mean dosage of urokinase were 4.5 hours and 927,000 units, respectively. Immediate recanalization was achieved in 10 patients (45%) after urokinase therapy. In patients with successful recanalization, rapid amelioration of symptoms followed the restoration of blood flow. Thrombolytic recanalization was associated with reduction of neurologic deficits and of computed tomography-demonstrable infarction volume. The reduction of infarction volume and functional outcome correlated highly with the degree of reflow. Hemorrhagic transformation of infarction occurred in four patients and controllable extracranial bleeding in three patients. These results support the safety and efficacy of urokinase therapy for acute thromboembolic occlusion of the middle cerebral artery. (Stroke

Safety of High Doses of Urokinase and Reteplase for Acute Ischemic Stroke

“…17 In AIS studies, the Middle Cerebral Artery Embolism Local Fibrinolytic Intervention Trial used IA UK doses Ͻ1,000,000 U 18 on the basis of a small case series of patients with acute MCA occlusions treated long before the availability of IVT. 19 UK is no longer available for use in the United States, and current ongoing clinical trials are using rtPA. The ongoing Interventional Management of Stroke (IMS) III trial limits the IA dose of rtPA to 22 mg. 20 Furthermore, patients randomized to receive ET in the IMS III trial receive two-thirds the standard FDA-approved dose of IVT.…”

Intra-Arterial Thrombolytic Therapy İn Acute İschemic Stroke: Uludag University Medical Faculty Neurology Clinic Experience

“…Bununla birlikte özellikle rt-PA için henüz, güvenli etkinlik dozunu belirleyecek karşılaştırılmalı randomize çalışmalar yapılmamıştır. Değişik çalışmalarda, 20-40 mg dozun güvenlik sınırları içerisinde olduğu belirtilmiştir (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Kendi serimizde rt-PA dozunu 20 mg'ın üzerine çıkmamaya çalıştık (6-26 mg arasında değişmek üzere ortalama 12 mg).…”

Endovascular treatment in acute ischemic stroke

“…This delivery technique permits high concentrations of lytic agent to be applied to the clot while minimising systemic exposure. MRI studies have provided striking imaging evidence of the potential beneficial effects of IA therapy (12,15). As with other interventional techniques used in acute stroke, the major disadvantages to IAT include the relative complexity of the procedure, the level of required technical expertise, relatively selective availability, delays in initiating treatment, and the additional risks and expense of an invasive procedure compared with IVT.…”