Abstract
We investigated follow-up angiography and outcome in 28 patients undergoing local fibrinolytic therapy (LFT) for intracranial or cervical artery occlusion to determine the incidence of distal shift of the embolus or no apparent angiographic change. The location of the occlusion was the cervical internal carotid artery (ICA) in 6 cases, the intracranial ICA in 8 cases, the horizontal portion of the middle cerebral artery (Ml) in 8 cases, the distal middle cerebral artery (MCA) in 5 cases, and the posterior cerebral artery (PCA) in 1 case. Angiography the day after LFT demonstrated recanalization in 2 cases of cervical ICA occlusion, 4 cases of intracranial ICA occlusion, 7 cases of M1 occlusion, and 6 cases of MCA and PCA occlusion. No apparent angiographic change was found in 2 cases of cervical ICA occlusion. Various distal shifts were found in the other 3 cases. Five patients died, 3 of severe brain edema, 1 of hemorrhagic infarction due to recanalization, and 1 of gastrointestinal bleeding. In many cases spontaneous recanalization after LFT was achieved by the next day. Although recanalization may not occur immediately after LFT, spontaneous recanalization often occurs in the early stage, so the zone of penumbra can be rescued with a low incidence of hemorrhagic infarction.
