title: Percutaneous transluminal angioplasty adjunct to thrombolysis for acute middle cerebral artery rethrombosis.
abstract: OBJECTIVE
  To report three patients, each of whom had acute rethrombosis of a reopened middle cerebral artery after urokinase treatment for proximal stenosis (percutaneous transluminal angioplasty of the stenosis was performed adjunctive to the thrombolytic treatment to preserve the success of the thrombolysis), and a fourth patient who had percutaneous transluminal angioplasty right after the completion of thrombolysis and had no rethrombosis despite a partial dilatation of the severe stenosis.
  
  
  METHODS
  Thrombolytic treatment was carried out by a coaxial technique with a Tracker 18 catheter through a 5-F angiographic catheter; 80,000 U in 5 mL of urokinase were intermittently injected every 15 minutes after an initial dose of 250,000 U. All patients were given 3000 U of heparin with a booster dose of 1000 U every hour. Angioplasty was performed with a Stealth catheter balloon, 2 to 3 mm x 1.5 cm.
  
  
  RESULTS
  Three patients recovered without hemorrhage after percutaneous transluminal angioplasty and thrombolytic treatment. Percutaneous transluminal angioplasty was unsuccessful in one patient because of the inability to pass a 2-mm Stealth balloon catheter, and the result was a second rethrombosis. This patient had a poor recovery.
  
  
  CONCLUSIONS
  Acute thrombosis of the middle cerebral artery may be associated with severe proximal stenosis. Rethrombosis may occur even after complete thrombolysis. Percutaneous transluminal angioplasty may be safely performed to prevent rethrombosis.
authors.affiliation: University of Missouri, Kansas City School of Medicine 64108.
authors.forename: F Y
authors.initials: FY
authors.lastname: Tsai
authors.forename: B
authors.initials: B
authors.lastname: Berberian
authors.forename: V
authors.initials: V
authors.lastname: Matovich
authors.forename: M
authors.initials: M
authors.lastname: Lavin
authors.forename: K
authors.initials: K
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015912:Thrombolytic Therapy / Q000295:instrumentation*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D014568:Urokinase-Type Plasminogen Activator