title: Percutaneous balloon angioplasty for acute occlusion of intracranial arteries.
abstract: BACKGROUND
  The benefits of intravenous thrombolysis for acute ischemic stroke are still limited.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries.
  
  
  METHODS
  Fifty-nine patients with acute occlusion of intracranial arteries were enrolled. A Gateway balloon catheter was used to disrupt clots or dilate atheromatous plaques in every patient. The technical details, technique-related complications, recanalization rates, and clinical outcomes were analyzed.
  
  
  RESULTS
  The occlusion sites were internal carotid arteries in 17 patients, M1 segments in 32 patients, the M2 segment in 1 patient, a vertebral artery in 1 patient, and basilar arteries in 8 patients. Twenty-four patients (41%) were treated with thrombolysis first, and 20 patients (34%) were treated with percutaneous transluminal angioplasty (PTA) followed by thrombolysis. PTA alone was performed in 15 patients (25%). The mean dose of urokinase was 205 x 10 U. The extent of recanalization was complete (Thrombolysis in Myocardial Infarction [TIMI] score of 3) in 17 patients (29%), and partial (TIMI 1/2) in 28 patients (47%). Functional independence at discharge was preserved in 76%, 25%, and 7% of patients with TIMI 3, TIMI 1/2, and TIMI 0, respectively. A combination of PTA and thrombolysis resulted in a significantly higher recanalization rate than PTA only. Seven patients (12%) experienced hemorrhagic events after treatment. Severe parenchymal hemorrhage with neurologic deterioration was observed in 2 patients (4%), and vessel rupture was encountered in 1 atherosclerotic case.
  
  
  CONCLUSIONS
  Mechanical angioplasty using a Gateway catheter combined with a low-dose thrombolytic agent is a safe and effective treatment for acute intracranial embolic and atherosclerotic occlusion with a low risk of hemorrhagic complications.
authors.affiliation: Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. kojitoku@md.okayama-u.ac.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Tokunaga
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugiu
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Yoshino
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Terai
authors.forename: Takashi
authors.initials: T
authors.lastname: Imaoka
authors.forename: Akira
authors.initials: A
authors.lastname: Handa
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hirotsune
authors.forename: Noboru
authors.initials: N
authors.lastname: Kusaka
authors.forename: Isao
authors.initials: I
authors.lastname: Date
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D002539:Cerebral Arterial Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator