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(Stroke. 1999;30:2094-2100.)
© 1999 American Heart Association, Inc.
Original Contributions |
Predictors of Clinical Improvement, Angiographic Recanalization, and Intracranial Hemorrhage After Intra-Arterial Thrombolysis for Acute Ischemic Stroke
Presented in part at the 121st Annual Meeting of the American Neurological Association, Miami, Fla, October 13–16, 1996.
From the Departments of Neurology (J.I.S., O.Z., C.K., D.M.D.L.), Neuroradiology (J.L.S., R.T.), and Neurosurgery (J.I.S., W.R.S.), University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio.
Correspondence to Jose I. Suarez, MD, Department of Neurology, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106. E-mail jis4{at}po.cwru.edu
Background and Purpose—We sought to evaluate predictors of clinical outcome, angiographic success, and adverse effects after intra-arterial administration of urokinase for acute ischemic stroke.
Methods—We designed a Brain Attack program at University Hospitals of Cleveland for diagnosis and treatment of patients presenting within 6 hours of onset of neurological deficit. Patients with ischemia referable to the carotid circulation were treated with intra-arterial urokinase. Angiographic recanalization was assessed at the end of medication infusion. Intracerebral hemorrhage was investigated immediately after and 24 hours after treatment. Stroke severity was determined, followed by long-term outcome.
Results—Fifty-four patients were treated. There was improvement
of 
4 points on the National Institutes of Health Stroke Scale from
presentation to 24 hours after onset in 43% of the treated
patients, and this was related to the severity of the initial deficit.
Forty-eight percent of patients had a Barthel Index score of 95 to 100
at 90 days, and total mortality was 24%. Cranial CT scans revealed
intracerebral hemorrhage in 17% of patients in
the first 24 hours, and these patients had more severe deficits at
presentation. Eighty-seven percent of patients received
intravenous heparin after thrombolysis, and
9% of them developed a hemorrhage into infarction.
Angiographic recanalization was the rule in
complete occlusions of the horizontal portion of the middle cerebral
artery, but distal carotid occlusions responded less well to
thrombolysis.
Conclusions—The intra-arterial route for thrombolysis allows for greater diagnostic precision and achievement of a higher concentration of the thrombolytic agent in the vicinity of the clot. Disadvantages of this therapy lie in the cost and delay. Severity of stroke and site of angiographic occlusion may be important predictors of successful treatment.
Key Words: hemorrhage • stroke, ischemic • thrombolysis
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|
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