Intraarterial therapy for acute ischemic stroke: investigation of prognostic factors.
BACKGROUND
Intraarterial therapy (IAT) for acute cerebral infarction has been proven to be profitable. However, the criteria for the indications, the choice of the thrombolytic agents, and the use of adjunctive agents are controversial. We retrospectively analyzed the prognostic factors of IAT.


METHODS
From 1994 to 2003, 28 patients underwent IAT due to middle cerebral artery occlusion (17 women and 11 men; median age, 69 years old). We evaluated the following prognostic parameters: institution of treatment, degree of paralysis at visit, size of high-intensity area on diffusion-weighted images, dose of intraarterial urokinase administration, elapsed time from symptom onset to completion of IAT, presence of penetration of embolus by microcatheter and microguidewire, recanalization after IAT, intracranial hemorrhage (ICH) within 24 hours after IAT, and intravenous heparin administration after IAT. The outcome was evaluated at discharge and was classified into the following categories according to the modified Rankin Scale: independence (0 to 2), dependence (3 to 5), and death (6).


RESULTS
Seven patients were judged to be independent, 16 patients were judged to be dependent, and five patients died. Patients with recanalization after IAT had a better outcome than those without (p < 0.05); patients with intracranial hemorrhage had a worse outcome than those without (p < 0.05); and patients with intravenous heparin administration after IAT had a better outcome in activities of daily living than those without (p < 0.05).


CONCLUSIONS
In addition to ICH and recanalization, our results suggested that intravenous heparin administration after IAT had a favorable effect on patient outcome.
Noguchi
Tomoyuki
T
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University.
Yoshiura
Takashi
T
Oguri
Shuichi
S
Hiwatashi
Akio
A
Togao
Osamu
O
Yamashita
Kouji
K
Nagao
Eiki
E
Murakami
Junji
J
Mihara
Futoshi
F
Honda
Hiroshi
H
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000628:therapy*; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
D014568:Urokinase-Type Plasminogen Activator