Intra-arterial cerebral thrombolysis for acute ischemic stroke in a community hospital.
OBJECTIVE
Advances in thrombolytic therapy, brain imaging, and neurointerventional techniques provide new therapeutic options for acute stroke. Intra-arterial thrombolysis has proved to be a potent therapeutic tool. To show that this procedure can be performed in community hospitals, we describe our experience with a group of 11 patients treated for middle cerebral artery occlusions.


METHODS
Twenty-two patients seen during a period of 1 year with clinical findings of acute major-vessel stroke met screening criteria and were evaluated under an institutional review board-approved protocol. After CT scanning, 17 of those patients met strict criteria, gave informed consent, and underwent angiography. Eleven patients had M1 and M2 middle cerebral artery occlusions and received local thrombolytic therapy with urokinase. Recanalization efficacy, complications, and outcome data were compiled.


RESULTS
The average score on the National Institutes of Health Stroke Scale was 22.2 at the onset of treatment and 12.5 after therapy, with 91% of patients showing neurologic improvement. Complete (TIMI 3) recanalization occurred in 73% of cases and partial recanalization (TIMI 2) in 18%. At the 90-day follow-up evaluation, 56% of patients had good outcomes (modified Rankin score, 0 to 1). One intracranial hemorrhage occurred.


CONCLUSIONS
Intra-arterial thrombolysis can be performed in a community hospital by radiologists with interventional and neuroradiologic skills given appropriate institutional preparation.
Edwards
M T
MT
Department of Radiology, Sacred Heart Hospital, Eau Claire, WI 54701, USA.
Murphy
M M
MM
Geraghty
J J
JJ
Wulf
J A
JA
Konzen
J P
JP
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000187:drug effects; D009460:Neurologic Examination / Q000187:drug effects; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
D014568:Urokinase-Type Plasminogen Activator