Intra-arterial thrombolysis of acute iatrogenic intracranial arterial occlusion attributable to neuroendovascular procedures or coronary angiography.
OBJECTIVE
For selected stroke patients, intra-arterial thrombolysis (IAT) has been shown to be an effective treatment option. However, knowledge of safety and efficacy of IAT in patients with acute stroke as a complication of arterial catheter interventions is limited.


METHODS
We analyzed clinical radiological findings and functional outcomes in consecutive patients 3 months after treatment with IAT for peri-procedural strokes occurring during neuroendovascular or cardiac catheter interventions. To measure outcome, the modified Rankin scale score was used.


RESULTS
Of a total of 432 patients treated with IAT, 12 (4 women and 8 men; mean age, 60 years) were treated because of an ischemic stroke after a neuro-endovascular procedure (n=6) or coronary angiography (n=6). The median baseline National Institutes of Health Stroke Scale score was 15. Recanalization was complete (thrombolysis in myocardial infarction grade 3) in 6, partial (thrombolysis in myocardial infarction 2) in 5, and minimal (thrombolysis in myocardial infarction 1) in 1. Nine patients (75%) had a favorable outcome (modified Rankin scale score, 0 to 2), and 3 had a poor outcome (modified Rankin scale score, 3 or 4). All patients with complete recanalization had a favorable outcome, whereas only 3 of 6 patients with partial or minimal recanalization (P=0.18) had a favorable outcome. Follow-up brain imaging was normal in 2 and showed new ischemic lesions in 10 patients. Two patients (17%) had a symptomatic intracerebral hemorrhage.


CONCLUSIONS
In acute stroke attributable to arterial catheter interventions, IAT is feasible and has the potential to improve outcome in these patients. A high recanalization rate could be achieved.
Arnold
Marcel
M
Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Fischer
Urs
U
Schroth
Gerhard
G
Nedeltchev
Krassen
K
Isenegger
Joerg
J
Remonda
Luca
L
Windecker
Stephan
S
Brekenfeld
Caspar
C
Mattle
Heinrich P
HP
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002339:Carotid Arteries / Q000503:physiopathology / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D017023:Coronary Angiography / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease; D020766:Intracranial Embolism / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000379:methods* / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator