Abstract
So far there has been two ways of performing intraarterial thrombolysis for acute embolic stroke: regional and local thrombolysis. If thrombolysis is done with a catheter tip placed in the cervical cerebral artery, it is called regional thrombolysis, and if it is done with a catheter tip placed in the intracranial cerebral artery, it is called local thrombolysis.
In this report, we introduce a new technique for the further improvement of efficacy of intraarterial thrombolysis. This technique could be briefly summarized as follows: first, a tip a 0.016″radifocus GT guide wire was passed beyond an embolus with the aid of DSA roadmaps, then a radifocus GT catheter was advanced and a tip of the catheter was placed just distal to the embolus, where injection of a fibrinolytic agent was initiated to dissolve an embolus from distally. We have modified and refined this technique, introduced by Herman Zeumer, and called this technique “central thrombolysis” to stress the closed relationship of catheter tip to embolus. Points of prime importance to prevent perforation of vessel wall are as follows:
1) Meticulous manipulation of a catheter and a guide wire with the aid of:
2) high quality roadmap on DSA,
3) high-torque and low-friction guide wire, and low friction and floppy catheter.
The advantages of “central thrombolysis” were confirmed on clinical cases, i.e. a greater number of arteries were recanalized with fewer doses of fibrinolytic agent and less time.
