title: Intra-arterial thrombolysis using double devices: mechanicomechanical or chemicomechanical techniques.
abstract: OBJECTIVE
  To optimize the recanalization of acute cerebral stroke that were not effectively resolved by conventional intraarterial thrombolysis (IAT), we designed a double device technique to allow for rapid and effective reopening. In this article, we describe the feasibility and efficacy of this technique.
  
  
  METHODS
  From January 2008 to September 2009, twenty patients with acute cerebral arterial occlusion (middle cerebral artery : n=12; internal carotid artery terminus : n=5; basilar artery : n=3) were treated by the double device technique. This technique was applied when conventional thrombolytic methods using drug, microwires, microcatheters and balloons did not result in recanalization. In the double device technique, two devices are simultaneously placed at the lesion (for example, one microcatheter and one balloon or two microcatheters). Chemicomechanical or mechanicomechanical thrombolysis was performed simultaneously using various combinations of two devices. Recanalization rates, procedural time, complications, and clinical outcomes were analyzed.
  
  
  RESULTS
  The initial median National Institute of Health Stroke Scale (NIHSS) was 16 (range 5-26). The double device technique was applied after conventional IAT methods failed. Recanalization was achieved in 18 patients (90%). Among them, 55% (11 cases) were complete (thrombolysis in cerebral infarction 2B, 3). The median thrombolytic procedural time including the conventional technique was 135±83.7 minutes (range 75-427). Major symptomatic hemorrhages (neurological deterioration ≥4 points in NIHSS) developed in two patients (10%). Good long term outcomes (modified Rankin Scale ≤2 at 90 days) occurred in 25% (n=5) of the cases. Mortality within 90 days developed in two cases (10%).
  
  
  CONCLUSIONS
  The double device technique is a feasible and effective technical option for large vessel occlusion refractory to conventional thrombolysis.
authors.affiliation: Department of Neurosurgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Park
authors.forename: Gyo Jun
authors.initials: GJ
authors.lastname: Hwang
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Jin
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Bang
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon