Abstract
We report 18 patients with acute thromboembolic occlusion of the middle cerebral artery (MCA) who were treated with superselective urokinase infusion.
The overall recanalization rate of our cases was 78%. The duration of the urokinase infusion from the onset and the decrease of rCBF are significant factors to achieve recanalization. For complete recanalization, treatment should be started within 180 minutes after the onset and more than 60% residual rCBF should be attained compared with an unaffected hemisphere on SPECT.
A characteristic feature was found in the recanalization of the MCA. The recanalization rate of the occluded posterior trunk of the MCA was 90%, but merely 20% of the anterior trunk.
All 3 cases of the proximal occlusion of the MCA revealed an infarction of basal ganglia, and hemorrhagic transformation of infarction occurred in 2 patients.
These results show the efficacy of intra-arterial urokinase infusion for acute thromboembolic occlusion of the MCA and the difficulties of recanalization of the anterior trunk of the MCA.
