Outcome Evaluation of Intra-arterial Infusion of Urokinase for Acute Ischemic Stroke

Abstract

Acute occlusion of the intracranial artery probably causes sudden severe neurological ischemic change, and the prognosis is poor (1, 2). In patients with acute ischemic stroke, intra-arterial infusion of urokinase has To evaluate the results of intra-arterial urokinase thrombolysis in cases of acute ischemic stroke and to define the factors affecting prognosis.Forty-eight patients with angiographically proven occlusion of the intracranial arteries were treated with local intra-arterial infusion of urokinase within six hours of the onset of symptoms. Neurologic status was evaluated on admission and on discharge using the NIH(National Institute of Health) stroke scale score (SSS). When the SSS decreased by at least four points, this was considered indicative of an improved clinical outcome.Complete recanalization was achieved in 17/48 patients (35%), including 8 of 13 (62%) with occlusion of the vertebrobasilar artery (VBA), 9 of 20 (45%) with occlusion of the middle cerebral artery (MCA), and none of 15 with occlusion of the internal carotid artery (ICA). Neurologic status improved in 12 (60%) of patients with MCA occlusion, in five (38%) of those with VBA occlusion and in three (20%) of those with ICA occlusion (P<0.05). Patients in whom occluded MCA was completely recanalized showed greater clinical improvement than those with partial or no recanalization (P<0.05). The overall mortality rate was 21%, 43% (9/21) in patients in whom CT revealed signs of early infarct, but only 4% (1/27) in those without this sign (P<0.05). The mortality rate of patients with parenchymal hematoma (4/5) was higher than that of those with hemorrhagic infarct (3/9) or without hemorrhage (3/34) (P<0.05).In patients in whom occluded MCA was completely recanalized, the clinical outcome was better, while patients with VBA occlusion did not benefit from recanalization. The presence on CT scans of signs of early infarct and of parenchymal hematoma after thrombolysis correlated with a high mortality rate.Brain, blood flow Brain, ischemia Thrombolysis Urokinase

Review of the Current Status of Intra-Arterial Thrombolysis for Treating Acute Cerebral Infarction: a Retrospective Analysis of the Data from Multiple Centers in Korea

“…However, in Korea, this procedure has yielded variable results (9-11). A combination of microcatheter techniques with their improved performance has increased the effectiveness and safety of IA thrombolysis.…”

“…With the first successful use of local intra-arterial (IA) thrombolysis for vertebrobasilar disease ( 1 ), many studies have shown that IA application of thrombolytics can successfully treat hyperacute ischemic strokes ( 2 - 8 ). However, in Korea, this procedure has yielded variable results ( 9 - 11 ). A combination of microcatheter techniques with their improved performance has increased the effectiveness and safety of IA thrombolysis.…”