title: Safety and efficacy of delayed intraarterial urokinase therapy with mechanical clot disruption for thromboembolic stroke.
abstract: OBJECTIVE
  To evaluate safety and efficacy of delayed intraarterial urokinase therapy with mechanical disruption of clot to treat thromboembolic stroke.
  
  
  METHODS
  Thirteen patients with cerebral thrombolic disease (10 carotid territory, 3 basilar territory) were treated with catheter-directed intraarterial urokinase therapy with mechanical disruption of the clots. All patients were excluded from a 6-hour multicenter thrombolytic trial by either time, recent surgery, age, seizure, or myocardial infarction. Time elapsed before treatment ranged from 3.5 to 48 hours (12 +/- 13 hours), with 200,000 to 900,000 U of urokinase used.
  
  
  RESULTS
  Ten patients had successful vessel recanalization, confirmed by repeat angiography. Cases with distal branch vessel occlusions were less likely to recanalize. Asymptomatic hemorrhagic conversion occurred in 2 patients on repeat scans. Both acute neurologic and functional outcomes were assessed with significant improvement occurring in 9 (69%) of 13 patients at 48 hours (greater than four-point change on the National Institutes of Health scale) and in 100% of 3-month survivors. All patients who improved had normal initial CT scans.
  
  
  CONCLUSIONS
  Intraarterial cerebral thrombolysis with mechanical disruption of clot seems to be a useful therapy in selected stroke cases even after 6 hours.
authors.affiliation: Department of Neurosurgery, Oregon Health Sciences University, Portland 97201.
authors.forename: S L
authors.initials: SL
authors.lastname: Barnwell
authors.forename: W M
authors.initials: WM
authors.lastname: Clark
authors.forename: T T
authors.initials: TT
authors.lastname: Nguyen
authors.forename: O R
authors.initials: OR
authors.lastname: O'Neill
authors.forename: M L
authors.initials: ML
authors.lastname: Wynn
authors.forename: B M
authors.initials: BM
authors.lastname: Coull
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002533:Cerebral Angiography; D002648:Child; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014568:Urokinase-Type Plasminogen Activator