Thrombolytic therapy in acute occlusion of the intracranial internal carotid artery bifurcation.
OBJECTIVE
To evaluate efficacy and clinical benefit of early thrombolytic therapy in intracranial internal carotid artery occlusion.


METHODS
Thirty-two patients (mean age, 56 years) with acute intracranial internal carotid artery occlusion were studied clinically and with CT and angiography before and after thrombolytic therapy with intravenous alteplase (n = 16), superselective intraarterial alteplase (n = 8), and superselective intraarterial urokinase (n = 8).


RESULTS
Initial CT showed a large parenchymal hypodensity in 11 (34%) patients, a small hypodensity in 15 (47%) patients, and no hypodensity in 6 (19%) patients. Recanalization after thrombolytic therapy was observed in 4 patients (12.5% in each treatment group). Follow-up CT showed six hemorrhagic infarcts and four parenchymal hematomas unrelated to recanalization, alteplase, or urokinase administration, but commonly associated with intraarterial treatment. Clinical outcome was fatal in 53%, poor in 31%, and moderate or good in 16% of the patients. Outcome was equal in different treatment groups and closely linked to both the quality of leptomeningeal collaterals and the extent of parenchymal hypodensity on the first CT.


CONCLUSIONS
Because intravenous or intraarterial treatment with alteplase or urokinase fails to recanalize the vascular obstruction, it does not improve the prognosis of intracranial internal carotid artery occlusion over that of the natural course. Improved results may be possible with novel recanalization techniques.
Jansen
O
O
Department of Neuroradiology, University of Heidelberg, School of Medicine, Germany.
von Kummer
R
R
Forsting
M
M
Hacke
W
W
Sartor
K
K
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000187:drug effects; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D003097:Collateral Circulation / Q000187:drug effects / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008578:Meninges / Q000098:blood supply; D008875:Middle Aged; D011859:Radiography; D015996:Survival Rate; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator