Thrombolytic therapy in acute stroke.
OBJECTIVE
To report the safety and efficacy of local, direct, intra-arterial and intravenous fibrinolysis treatment in selected cases of clinically symptomatic patients with acute occlusion of the intracranial cerebral arteries and dural sinuses.


METHODS
Patients with acute progressive neurological deterioration, in spite of systemic anticoagulation and/or antiplatelet medications, presenting with occlusion of a major intracranial cerebral artery or dural sinus were tested. From a transfemoral approach through a guiding catheter, a 2.5F microcatheter was guided directly into the intracranial cerebral circulation and embedded within the clot. Infusion of urokinase was then performed directly into the thrombus until lysis was attained.


RESULTS
In 36 total patients, 27 cases were treated for an acute arterial occlusion in 45 vascular territories. Clinically, there was neurological improvement in 18 (66.7%) cases. Complications directly related to therapy included symptomatic intracranial hemorrhage in three cases (11.1%), which included 1 case (3.7%) of vessel perforation. In 8 (29.6%) patients, there was no evidence of clinical improvement, and in long-term follow-up there were 9 (33.3%) patient deaths. Nine patients were treated for an intracerebral dural sinus thrombosis in ten vascular territories by local urokinase infusion. In 7 (77.8%) cases, there was angiographic evidence of clot lysis and clinical improvement of the patient's neurological condition. Minor complications including infection and noncerebral sites of bleeding occurred in 3 (33.3%) patients, requiring adjustment in urokinase infusion therapy.


CONCLUSIONS
Local, direct intra-arterial or intravenous infusion of thrombolytic drugs for treatment of stroke patients may improve overall patient morbidity and mortality related to acute thromboembolic disease in the central nervous system. Further clinical studies are warranted to evaluate this form of therapy.
Higashida
R T
RT
Department of Radiology, University of California, San Francisco Medical Center 94143-0628, USA.
Halbach
V V
VV
Barnwell
S L
SL
Dowd
C F
CF
Hieshima
G B
GB
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation; D002533:Cerebral Angiography; D002536:Cerebral Arteries; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004388:Dura Mater; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D002542:Intracranial Embolism and Thrombosis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage* / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator