From the Departments of Neuroradiology (F.G., L.R., C.O., K.-O.L., G.S.)
and Neurology (F.G., H.M., M.S., R.B., C.B.), Inselspital, University of
Berne, Berne, Switzerland.
Correspondence to Gerhard Schroth, MD, Head of Neuroradiology, Inselspital, 3010 Bern, Switzerland. E-mail gerhard.schroth{at}insel.ch
Background and Purpose—We performed
a retrospective analysis of the prognostic factors in patients
treated with local intra-arterial
thrombolysis (LIT). The purpose of this study was to
evaluate the safety and efficacy of LIT using urokinase in patients
with acute ischemic stroke of the anterior or posterior
circulation and to determine the influence of clinical and radiological
parameters on outcome.
Methods—Forty-three patients were treated with LIT using
urokinase (median dose, 0.75x106 IU). The median National
Institutes of Health Stroke Scale (NIHSS) score at hospital admission
was 18 (range, 9 to 36). Nine patients had occlusions of the internal
carotid artery (ICA), 23 of the middle cerebral artery (MCA), 1 of the
anterior cerebral artery, and 10 of the basilar artery (BA). Outcome
was assessed after 3 months and classified as good for Rankin Scale
(RS) scores of 0 to 3 and poor for RS scores of 4 or 5 and death.
Results—Nine patients (21%) recovered to RS scores 0 or 1, 17
(40%) to scores of 2 or 3, and 7 (16%) to scores of 4 or 5. Ten
patients (23%) died. Outcome was good in 17 patients (80%) with MCA
occlusions, in 3 patients (33%) with ICA, and in 5 patients (50%)
with BA occlusions. Good outcome was associated with an initial NIHSS
score of <20 (P<0.001), improvement by 4 or more
points on NIHSS score within 24 hours (P=0.001), and
vessel recanalization (P=0.02).
Recanalization was more likely if LIT was started
within 4 hours (P=0.01). Symptomatic
cerebral hemorrhage occurred in 2 patients (4.7%).
Conclusions—LIT was most efficacious in patients with MCA and BA
occlusions when the initial NIHSS score was less than 20 and when
treated within 4 hours. It is of limited value in patients with distal
ICA occlusions.
© 1998 American Heart Association, Inc.
Original Contributions
Local Intra-Arterial Thrombolysis in Acute Ischemic Stroke
Key Words: angiography, digital subtraction • fibrinolysis • stroke, acute • thrombolysis • urokinase
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