Emergency Embolectomy and Thrombolytic Therapy for Acute Cerebral Thromboembolism

Abstract

Twenty-two patients with acute cerebral thromboembolism were treated with emergency embolectomy and thrombolytic therapy with urokinase. They were consisted of 15 males and 7 females and their average age was 71.4-year-old. All of them had thrombolic occlusion of the main intracerebral arteries and neither low nor high density area on CT scanning were detected on admission. They were treated within 6 hours since initial attack. The occlusive arteries were consisted of 3 internal carotid arteries, 17 of middle cerebral arteries, 1 of basilar artery, and 1 of superior cerebellar artery. 43.2×104 of urokinase was administrated intra-arteially in average. As result, complete recanalization was recognized in 1 case (4.5%), partial recanalization were in 13 cases (59.1%), and no recanalization was recognized in 8 cases (36.4%) on angiogram. Neurological improvement were detected in 8 cases (36.4%) and neurological deterioration were detected in 2 cases (9.1%). In 53.8% of the patients treated within 3 hours, neurological improvement were detected, otherwise, none of the patients treated over 3 hours showed neurological development. Furthermore, in 38.5% of the patients who revealed recanalization on anigiogram, neurological improvement were detected. Although, only in 12.5% of the patients who did not revealed recanalization, neurological improvement were detected. As complication with this therapy, in 3 patients, rupture of the vessels, mechanical spasm, and dissection of vessels were detected.