Endovascular neuroradiological treatment of acute ischemic stroke: techniques and results in 350 patients.
OBJECTIVE
Randomized trials have demonstrated the benefit of intra-arterial thrombolysis (IAT) for treatment of acute ischemic stroke, if performed within 6 hours of symptom onset.


METHODS
We report our experience with 350 acute stroke patients who were treated with IAT using urokinase at a single center. Predictors of favorable outcome were low National Institute of Health Stroke Scale (NIHSS) at admission (p<0.001), good collaterals (p<0.001) and successful endovascular recanalization (p<0.001). Recanalization rates of more than 75% could be achieved, when additional endovascular techniques such as mechanical fragmentation of the thrombus, thromboaspiration, percutaneous transluminal angioplasty, and implantation of stents were used.


CONCLUSIONS
Predictors of unfavorable outcome were diabetes mellitus (p<0.001) and symptomatic hemorrhages (p<0.001). The latter occurred in 5% of our population. Preliminary results of new techniques including sonothrombolysis, angiojet aspiration, and laser recanalization of thromboembolic occlusions are discussed.
Brekenfeld
Caspar
C
Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Switzerland.
Remonda
Luca
L
Nedeltchev
Krassen
K
v Bredow
Ferdinand
F
Ozdoba
Christoph
C
Wiest
Roland
R
Arnold
Marcel
M
Mattle
Heinrich P
HP
Schroth
Gerhard
G
D001488:Basilar Artery; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D002533:Cerebral Angiography; D006801:Humans; D008875:Middle Aged; D020768:Middle Cerebral Artery; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome