Abstract
Purpose: We evaluated the efficacy and limitation of the intra-arterial local fibrinolytic therapy for acute thromboembolic stroke.
Method: After exclusion of intracranial hemorrhage by CT scan, patients with abrupt onset of focal ischemic symptoms underwent angiography within 7 hours after ictus. Patients with thromboembolisms received 24×104 IU of urokinase or 10 megaunits of recombinant tissue plasminogen activator through a microcatheter placed into the occluded lesion for 20 minutes. When arterial recanalization was not achieved, a second or third infusion was performed. Recanalization efficacy was assessed at the end of fibrinolytic therapy and intracranial hemorrhage was assessed at 24 hours later. The results were compared with those of 54 patients treated with intracarotid (21 cases) or intravenous (33 cases) infusion of fibrinolytic agents.
Result: The rate of recanalization was 71%. Middle cerebral artery and basilar artery occlusion demonstrated a high rate of recanalization (80%and 94% respectively). However only 30%of patients with internal carotid artery occlusion showed recanalization. There was no difference between tissue plasminogen activator and urokinase in restoring blood flow. In the intracarotid infusion group (20×104 IU of urokinase for 30 minutes), only 3 patients showed recanalization without favorable outcome. The incidence of good outcome was higher in the intra-arterial local infusion group. In the patients with middle cerebral artery occlusion, 48%of patients with local therapy had a good recovery, while 24%in intracarotid and 32%in intravenous group had a good recovery. In the patients with basilar artery occlusion, only the local infusion group had a good outcome (24%). The incidence of hemorrhagic event within 24 hours was 28%, and only 2%clinically deteriorated.
Conclusion: Although this study is relatively small and further evaluation is needed, intra-arterial local fibrinolytic therapy can be effective for acute thromboembolic stroke.
