title: Intra-arterial thrombolysis in 24 consecutive patients with internal carotid artery T occlusions.
abstract: OBJECTIVE
  To determine the safety, efficacy, and predictors of favourable outcome of intra-arterial thrombolysis in acute stroke attributable to internal carotid "T"occlusion
  
  
  METHODS
  The authors analysed 24 consecutive patients with T occlusions of the internal carotid artery treated by local intra-arterial thrombolysis using urokinase.
  
  
  RESULTS
  The median baseline National Institutes of Health Stroke Scale was 19. The average time from symptom onset to treatment was 237 minutes. Four patients (16.6%) had a favourable (modified Rankin Scale score (mRS</=2)) and 10 patients (41.7%) a poor outcome (mRS 3 or 4) after three months. Ten patients (41.7%) died. One symptomatic intracerebral haemorrhage (4.2%) occurred. Partial recanalisation of the intracranial internal carotid artery was achieved in 15 (63%), of the middle cerebral artery in four (17%), and of the anterior cerebral artery in eight patients (33%). Complete recanalisation never occurred. Sufficient leptomeningeal collaterals as seen on arteriography (p=0.02) and age <60 years (p=0.012) were the only predictors of favourable clinical outcome.
  
  
  CONCLUSIONS
  Acute stroke attributable to carotid T occlusion remains a condition with a generally poor prognosis even when intra-arterial thrombolysis is performed. Favourable outcome was seen only in patients with sufficient leptomeningeal collaterals.
authors.affiliation: Department of Neurology, University Hospital of Berne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: K
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: H P
authors.initials: HP
authors.lastname: Mattle
authors.forename: T J
authors.initials: TJ
authors.lastname: Loher
authors.forename: F
authors.initials: F
authors.lastname: Stepper
authors.forename: G
authors.initials: G
authors.lastname: Schroth
authors.forename: C
authors.initials: C
authors.lastname: Brekenfeld
authors.forename: M
authors.initials: M
authors.lastname: Sturzenegger
authors.forename: L
authors.initials: L
authors.lastname: Remonda
mesh_terms: D000328:Adult; D000368:Aged; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator