title: Angiographic A-V Shunt during Interventional Thrombolysis for Acute Cerebral Embolism. A New Predictive Sign for Hemorrhagic Complication.
abstract: In order to predict the post-therapeutic hemorrhagic complication of interventional thrombolysis, we retrospectively examined angiographic findings and other factors in 44 patients with acute cerebral embolism. All patients were super selectively catheterized within 5 hours of onset and received a fixed regimen of urokinase or t-PA, unless recanalization was achieved or deterioration was apparent before total infusion. Immediate post-therapeutic CT scan revealed hematoma within the basal ganglia in 10 patients (group 1) and no hemorrhage in the remaining 34 (group 2). A series of angiograms during the therapy showed A-V shunt from lenticulostriate arteries to thalamostriate vein in 7 of 10 cases in group 1; no case in group 2 was accompanied by such abnormal shunt. Prognosis after the therapy was worse in group 1 than in group 2. No other factors, such as therapeutic timing after the disease onset or total doses of urokinase or t-PA infused, differed between the two groups. These findings indicate that angiographic A-V shunt during therapy is a predictive sign of a high incidence of hemorrhagic complication. We recommend performing several angiographic controls during therapy and when A-V shunt is detected, the therapy should be discontinued to prevent hemorrhage which leads to a poor prognosis.
authors.affiliation: Department of Neurosurgery, Shizuoka City Hospital; Shizuoka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Fukazawa
authors.forename: R
authors.initials: R
authors.lastname: Waki
authors.forename: A
authors.initials: A
authors.lastname: Hidaka
authors.forename: R
authors.initials: R
authors.lastname: Kishimoto
authors.forename: K
authors.initials: K
authors.lastname: Kimura
authors.forename: N
authors.initials: N
authors.lastname: Tamakawa
authors.forename: H
authors.initials: H
authors.lastname: Teramachi
authors.forename: K
authors.initials: K
authors.lastname: Shimizu