title: Simple microwire and microcatheter mechanical thrombolysis with adjuvant intraarterial urokinase for treatment of hyperacute ischemic stroke patients.
abstract: BACKGROUND
  Mechanical thrombolysis may effectively enhance the efficacy of thrombolysis for hyperacute ischemic stroke patients.
  
  
  OBJECTIVE
  To assess the feasibility and results of simple mechanical-based thrombolysis using microwire and microcatheter with adjuvant low-dose intraarterial (i.a.) urokinase (UK) for the treatment of hyperacute ischemic stroke.
  
  
  METHODS
  Nineteen consecutive patients with hyperacute proximal middle cerebral artery (MCA) occlusions treated by a standardized protocol using microwire and microcatheter for mechanical thrombus disruption with adjuvant i.a. UK were reviewed. Simple to-and-fro passages through the clot with the microwire and microcatheter followed by disruptions by a J- or pigtail-shaped wire tip with alternating small-dose injections of UK distal, within, and proximal to the clot were performed. The recanalization rates, post-thrombolysis hemorrhage, and clinical outcome (baseline and discharge National Institute of Health Stroke Scale [NIHSS], mortality, 3-month modified Rankin scale [mRS]) were evaluated.
  
  
  RESULTS
  Recanalization was achieved in 18 of 19 patients (94.7%). The mean UK dose was 375,789 IU (range 130,000-580,000 IU). Two patients (10.5%) developed symptomatic hemorrhage. One of the hemorrhages included a patient who developed subarachnoid hemorrhage. Mortality rate was 15.8% (n = 3). The median baseline NIHSS scores showed improvement from 17 to 10 at presentation and discharge, respectively. At three months, good outcome was noted in 11 of 19 patients (57.9%, mRS 0-2).
  
  
  CONCLUSIONS
  Simple mechanical-based thrombolysis using microwire and microcatheter with adjuvant low-dose i.a. UK is safe and effective in achieving recanalization with good long-term outcome.
authors: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea. dikim@yumc.yonsei.ac.kr
authors: Dong Joon
authors: DJ
authors: Kim
authors: Dong Ik
authors: DI
authors: Kim
authors: Joon Soo
authors: JS
authors: Byun
authors: Jin Young
authors: JY
authors: Jung
authors: Sang Hyun
authors: SH
authors: Suh
authors: Eung Yeop
authors: EY
authors: Kim
authors: Kyung-Yul
authors: KY
authors: Lee
authors: Ji Hoe
authors: JH
authors: Heo
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy*; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator