2001 Volume 12 Issue 7 Pages 360-365
Background and Purpose: Super-selective thrombolytic therapy (STT) has only been applied in patients with brain embolism associated with known abnormalities such as atrial fibrillation in Japan. The purpose of this study is to report our experience with this therapy for acute phase atherothrombotic brain ischemia (TBI) to prevent from infarction. We compare the results of our study in patients with TBI with those of the same treatment in patients with embolic brain ischemia (EBI). Methods: STT consisted of intraarterial delivery of urokinase (UK) as the thrombolytic agent to the site of occlusion in 21 patients (10 patients with TBI and 11 with EBI). The maximum dose of UK used was 240, 000 IU. Immediate or rescue percutaneous transluminal angioplasty (PTA) was subsequently performed when recanalization failed or post-STT stenosis was >90%. The rates of successful recanalization, improvement of symptoms, required PTA, and occurrence of acute bleeding, and the total dose of UK, were compared between the two groups. Results: STT resulted in successful recanalization in all patients of both groups. The proportions of patients showing improvement of symptoms, required PTA, and those who developed acute bleeding, and the average dose of UK, were 90 and 73%, 10 and 9%, 10 and 18%, 114, 000 and 131, 000 IU in TBI and EBI groups, respectively. There were no significance differences in the above parameters between the two groups. Conclusions: The results of our STT showed high rate of improvement for TBI as well as EBI. We believe this STT will be a rather safe and recommendable treatment for the acute phase of TBI, as the catheters are improving continuously.
