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(Stroke. 2006;37:3002.)
© 2006 American Heart Association, Inc.

Original Contributions

Long-Term Effect of Intra-Arterial Thrombolysis in Stroke

Krassen Nedeltchev, MD; Urs Fischer, MD; Marcel Arnold, MD; Pietro Ballinari, MSc; Tobias Haefeli, MD; Liliane Kappeler, MD; Caspar Brekenfeld, MD; Luca Remonda, MD; Gerhard Schroth, MD Heinrich P. Mattle, MD

From Departments of Neurology (K.N., U.F., M.A., L.K., T.H., H.P.M.), Diagnostic and Interventional Neuroradiology (C.B., L.R., G.S.), and Psychology (P.B.), University of Bern, Switzerland.

Correspondence to Heinrich P. Mattle, MD, Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland. E-mail heinrich.mattle{at}insel.ch

Background and Purpose— Thrombolysis has been shown to improve the 3-month outcome of patients with ischemic stroke, but knowledge of the long-term effect of thrombolysis is limited.

Methods— The present study compares the long-term outcome of stroke patients who were treated with intra-arterial thrombolysis (IAT) using urokinase with the outcome of patients treated with aspirin. The modified Rankin Scale (mRS) was used to assess the outcome; 173 patients treated with IAT and 261 patients treated with aspirin from the Bernese Stroke Data Bank were eligible for the study. A matching algorithm taking into account patient age and stroke severity on admission (as measured by the National Institute of Health Stroke Scale [NIHSS]) was used to assemble an IAT and an aspirin group.

Results— One hundred and forty-four patients treated with IAT and 147 patients treated with aspirin could be matched and included in the comparative analysis. The median NIHSS score was 14 in each group. At 2 years, 56% of the patients treated with IAT and 42% of the patients treated with aspirin achieved functional independence (mRS, 0 to 2; P=0.037). Clinical outcome was excellent (mRS, 0 to 1) in 40% of the IAT and in 24% of the aspirin patients (P=0.008). Mortality was 23% and 24%, respectively.

Conclusions— The present study provides evidence for a sustained effect of IAT when assessed 2 years after the stroke.

Key Words: intra-arterial thrombolysis • long-term outcome • stroke • urokinase