[Outcome of intraarterial procedures in acute ischemic stroke].
BACKGROUND
In addition to the thrombolytic agents, mechanical devices are being used in intraarterial procedures in acute stroke patients. The intervention protocol and outcomes of intraarterial procedures performed in the Hospital Virgen del Rocío in 2003-2004 are described.


METHODS
The results in each arterial occlusion site and case-control study of the middle cerebral artery (MCA), the placebo group in PROACT II study (Prolyse in Acute Cerebral Thromboembolism II) as historic control group, are described.


RESULTS
A total of 32 procedures were performed: 18 MCA occlusions, 8 basilar thrombosis and 6 intracranial carotid occlusions. Urokinase, abciximab and mechanical devices were used in 60%, 26% and 60% of the cases, respectively. MCA occlusions: 60% of the cases improved in 24 hours (25% remained asymptomatic). Only 25% controls remained independent versus 55% of the treated patients (p=0.001). Recanalization and complete recanalization rates were 95 % and 45 %, respectively (18% and 2% in the control group). Symptomatic intracranial hemorrhage (SICH) rate was 18% vs 4% in cases and controls. Basilar thrombosis: only one patient died and 57% of the remaining patients were independent. Carotid occlusions: no complete recanalization was achieved and only one patient was independent. Evolution time in SICH patients was longer (p=0.04), with increased international normalized ratio (INR) for thromboplastin time (p=0.06) and old ischemic lesions in brain CT scan (p=0.02) and they were more dependent at three months (p=0.01).


CONCLUSIONS
Intraarterial procedures in MCA occlusions achieve high rates of recanalization and better clinical outcomes than those described in isolated intraarterial thrombolysis. Long-term outcomes in basilar thrombosis were also excellent. Nevertheless, the natural evolution of carotid occlusions was not modified.
Martínez-Fernández
E
E
Servicio de Neurología. Hospital Universitario Virgen del Rocío, Sevilla, Spain. emartinezf@ya.com
González
A
A
Gil-Peralta
A
A
González-Marcos
J R
JR
Mayol Deyá
A
A
D001488:Basilar Artery / Q000473:pathology; D001921:Brain / Q000033:anatomy & histology / Q000473:pathology; D020520:Brain Infarction / Q000188:drug therapy*; D002343:Carotid Artery, Internal / Q000473:pathology; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy; D007261:Infusions, Intra-Arterial; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D010919:Placebos; D020521:Stroke / Q000188:drug therapy*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010919:Placebos