Local intra-arterial thrombolysis in acute ischemic stroke.
OBJECTIVE
We performed a retrospective analysis of the prognostic factors in patients treated with local intra-arterial thrombolysis (LIT). The purpose of this study was to evaluate the safety and efficacy of LIT using urokinase in patients with acute ischemic stroke of the anterior or posterior circulation and to determine the influence of clinical and radiological parameters on outcome.


METHODS
Forty-three patients were treated with LIT using urokinase (median dose, 0.75x10(6) IU). The median National Institutes of Health Stroke Scale (NIHSS) score at hospital admission was 18 (range, 9 to 36). Nine patients had occlusions of the internal carotid artery (ICA), 23 of the middle cerebral artery (MCA), 1 of the anterior cerebral artery, and 10 of the basilar artery (BA). Outcome was assessed after 3 months and classified as good for Rankin Scale (RS) scores of 0 to 3 and poor for RS scores of 4 or 5 and death.


RESULTS
Nine patients (21%) recovered to RS scores 0 or 1, 17 (40%) to scores of 2 or 3, and 7 (16%) to scores of 4 or 5. Ten patients (23%) died. Outcome was good in 17 patients (80%) with MCA occlusions, in 3 patients (33%) with ICA, and in 5 patients (50%) with BA occlusions. Good outcome was associated with an initial NIHSS score of <20 (P<0.001), improvement by 4 or more points on NIHSS score within 24 hours (P=0.001), and vessel recanalization (P=0.02). Recanalization was more likely if LIT was started within 4 hours (P=0.01). Symptomatic cerebral hemorrhage occurred in 2 patients (4.7%).


CONCLUSIONS
LIT was most efficacious in patients with MCA and BA occlusions when the initial NIHSS score was less than 20 and when treated within 4 hours. It is of limited value in patients with distal ICA occlusions.
Gönner
F
F
Department of Neuroradiology, Inselspital, University of Berne, Switzerland.
Remonda
L
L
Mattle
H
H
Sturzenegger
M
M
Ozdoba
C
C
Lövblad
K O
KO
Baumgartner
R
R
Bassetti
C
C
Schroth
G
G
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D001161:Arteriosclerosis / Q000150:complications; D001488:Basilar Artery; D001929:Brain Edema / Q000209:etiology / Q000401:mortality; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D001933:Brain Stem / Q000098:blood supply; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010960:Plasminogen Activators / Q000008:administration & dosage* / Q000009:adverse effects; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator