1995 Volume 17 Issue 2 Pages 168-174
A case of thrombosis of the left middle cerebral artery was treated by intra-arterial injection of urokinase (UK) by transbrachial superselective catheterization. The patient was a 69-year-old male who had experienced difficulty in speaking from the morning. After he was admitted to our hospital, his clinical condition worsened. Aphasia, right hemiparesis and disturbance of consciousness appeared. Based on the clinical course, atherothrombotic infarction was suspected. Emergency cerebral angiography was performed by right transbrachial approach, and complete left middle cerebral artery occlusion was diagnosed.
We employed a newly devised transbrachial cerebral catheter with which we can carry out superselective catheterization. After diagnosis, 480, 000 units of UK was administered intra-arterially using this highly selective catheterization. The injection produced a recovery of blood flow in the left middle cerebral artery and resulted in rapid amelioration of the clinical symptoms.
Intra-arterial injection of UK by superselective catheterization can be very effective in acute obstruction of the middle cerebral artery. As regards the technique of cerebral angiography, in many respects the transbrachial approach is preferable to the transfemoral approach. However, there have been no reports of transbrachial superselective thrombolytic therapy. We have demonstrated that it is possible to perform superselective catheterization using the transbrachial approach.
