Abstract
Purpose: We evaluated the efficacy of local intra-arterial fibrinolysis (LIF) in patients with acute ischemic stroke and sought to determine the influence of recanalization time and neuroradiological parameters on outcome.
Methods: We treated 103 patients with local intra-arterial injection of urokinase or recombinant tissue plasminogen activator within several hours after the onset of acute ischemic stroke. Thirty-four patients had occlusions of the internal carotid artery (ICA), 49 of the middle cerebral artery (MCA), and 20 of the vertebrobasilar artery (VBA). Outcome was assessed at the time of discharge and classified as excellent, good, fair, poor, and dead. The site of occlusion, recanalization time (from the onset of stroke to the accomplishment of recirculation), and collateral circulation on the angiogram (good, fair, or poor), and the outcome were evaluated.
Results: Recanalization and good (excellent and good) outcome were achieved in 21 (62%) and 8 (24%) of 34 patients with ICA occlusion, 39 (80%) and 30 (61%) of 49 patients with MCA occlusion, and 20 (100%) and 8 (40%) of 20 patients with VBA occlusion, respectively. The patients were divided into three groups according to the recanalization time of less than 3 hours (Group-I, 8 patients), 3 to 4 hours (Group-II, 31 patients), and more than 4 hours (Group-III, 41 patients). Outcome was good in all the 8 patients in Group-I without regard to the site of occlusion and collateral circulation. In Group-II and III, outcome was also good regardless of collateral circulation in patients with MCA-Mldistal or M2 occlusion, and that of the other patients in these groups was good only when they had a good collateral circulation.
Conclusions: LIF would be most efficacious in any patients with acute stroke when treated within 3 hours of onset and in patients with occlusion of Ml distal and M2 portion when treated after 3 hours. Other patients are good candidates of LIF only when they have good collateral circulation.
