Local Intra-Arterial Thrombolysis in Acute Ischemic Stroke

Abstract

Background and Purpose-We performed a retrospective analysis of the prognostic factors in patients treated with local intra-arterial thrombolysis (LIT). The purpose of this study was to evaluate the safety and efficacy of LIT using urokinase in patients with acute ischemic stroke of the anterior or posterior circulation and to determine the influence of clinical and radiological parameters on outcome. Methods-Forty-three patients were treated with LIT using urokinase (median dose, 0.75ϫ10 6 IU). The median National Institutes of Health Stroke Scale (NIHSS) score at hospital admission was 18 (range, 9 to 36). Nine patients had occlusions of the internal carotid artery (ICA), 23 of the middle cerebral artery (MCA), 1 of the anterior cerebral artery, and 10 of the basilar artery (BA). Outcome was assessed after 3 months and classified as good for Rankin Scale (RS) scores of 0 to 3 and poor for RS scores of 4 or 5 and death. Results-Nine patients (21%) recovered to RS scores 0 or 1, 17 (40%) to scores of 2 or 3, and 7 (16%) to scores of 4 or 5. Ten patients (23%) died. Outcome was good in 17 patients (80%) with MCA occlusions, in 3 patients (33%) with ICA, and in 5 patients (50%) with BA occlusions. Good outcome was associated with an initial NIHSS score of Ͻ20 (PϽ0.001), improvement by 4 or more points on NIHSS score within 24 hours (Pϭ0.001), and vessel recanalization (Pϭ0.02). Recanalization was more likely if LIT was started within 4 hours (Pϭ0.01). Symptomatic cerebral hemorrhage occurred in 2 patients (4.7%). Conclusions-LIT

Middle Cerebral Artery Thrombolysis Through the Contralateral Internal Carotid Artery-Case Report-

“…Angiographical ICA occlusion is considered impossible to treat successfully in most cases because of the high rate of complications such as hemorrhagic transformation or difficulty of restoration of the blood flow. 5,7,9,11) Rapid disruption or dissolution of the thrombus in the ICA is very difficult. We treated a patient admitted with acute profound stroke, caused by permanent ipsilateral ICA occlusion, by intracranial arterial thrombolysis in the ipsilateral middle cerebral artery (MCA) using a catheter passed through the contralateral ICA.…”

Impact of Retrievable Stents on Acute Ischemic Stroke Treatment

“…6,[14][15][16] We have used retrievable stents in addition to the established techniques since January 2010. This study evaluates the impact of the use of a retrievable stent on multimodal endovascular stroke treatment.…”

MR Imaging−Based Localized Intra-Arterial Thrombolysis Assisted by Mechanical Clot Disruption for Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion

“…Predictors of clinical outcome after MCD have not been analyzed, but factors associated with outcome after LIT alone have been evaluated in previous studies. Gönner et al 20 found that a good outcome at 3 months in 45 patients was associated with a baseline NIHSS score of Ͻ20, improvement by Ն4 NIHSS points within 24 hours, and vessel recanalization. Ueda et al 21 showed that poor outcome at 6 months in 76 patients was predicted by an NIHSS score of Ͼ20, cardioembolic infarction, low perfusion on single-photon emission CT, incomplete recanalization, and older age.…”