[Intraarterial thrombolysis in the treatment of acute ischemic stroke: Technical and clinical results].
OBJECTIVE
To evaluate the safety and recanalization efficacy of local IA rt-PA delivery in patients with acute ischemic stroke.


METHODS
Fifteen patients with acute ischemic stroke were treated; of these, 10 were carotid artery stroke, 5 were vertebrobasilar territory stroke cases. The neurological status of the patients were graded according to the Glascow Coma Scale and National Institutes of Heart Stroke Scale. All patients underwent a CT examination on admission. In addition, 4 patients had diffusion-weighted and one patient had a perfusion MR examination. Patients of carotid territory stroke were treated within 6 hours from the stroke onset. There was no time limitation for the basilar artery territory. The Rankin Scale (RS) was used as outcome measures.


RESULTS
Two of the 10 patients with carotid artery stroke had carotid territory occlusions, 8 had middle cerebral artery main trunk occlusions. Four patients had symptomatic hemorrhage; of these, 3 died within 24 hours. At the third month 4 patients had a good outcome. Of 5 patients with basilar artery stroke, 4 had basilar artery occlusions. In one patient, the basilar artery was open but the flow of the contrast material was very slow. Two patients with unsuccessful recanalization due to underlying high grade atherosclerotic stenosis and one patient with successful recanalization died. At the third month, the other patient with succesful recanalization had a poor outcome (RS 4). The patient with slow basilar artery flow developed from RS 5 to RS 1 and was discharged without any neurological deficit.


CONCLUSIONS
In acute ischemic stroke, local IA thrombolysis is a safe and feasible treatment when the right patient is selected. Hemorrhage does not exceed that which occurs in the natural history of the disease and with other treatment methods.
Baltacioğlu
Feyyaz
F
Marmara Universitesi Tip Fakültesi, Radyoloji Anabilim Dali, Istanbul.
Afşar
Nazire
N
Ekinci
Gazanfer
G
Elmaci
Neşe Tuncer
NT
Cimşit
N Cağatay
NC
Aktan
Sevinç
S
Erzen
Canan
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000473:pathology; D002341:Carotid Artery Thrombosis / Q000188:drug therapy / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use*; D015642:Radiology, Interventional; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000473:pathology
D010960:Plasminogen Activators