Stroke. 2002;33:1828-1833
doi: 10.1161/01.STR.0000020713.89227.B7
doi: 10.1161/01.STR.0000020713.89227.B7
(Stroke. 2002;33:1828.)
© 2002 American Heart Association, Inc.
Original Contributions |
Intra-Arterial Thrombolysis in 100 Patients With Acute Stroke Due to Middle Cerebral Artery Occlusion
From the Departments of Neurology (M.A., K.N., F.S., M.S., H.P.M.) and Neuroradiology (G.S., L.R.), Inselspital, University of Berne, Switzerland.
Correspondence to Heinrich Mattle, MD, Department of Neurology, University of Berne, Inselspital, Freiburgstrasse, CH-3010 Berne, Switzerland. E-mail heinrich.mattle{at}insel.ch
Background and Purpose— The purpose of this study was to evaluate the safety and efficacy of local intra-arterial thrombolysis (LIT) using urokinase in patients with acute stroke due to middle cerebral artery (MCA) occlusion.
Methods— We analyzed clinical and radiological findings and functional outcome 3 months after LIT with urokinase of 100 consecutive patients. To measure outcome, the modified Rankin scale (mRs) score was used.
Results— Angiography showed occlusion of the M1 segment of the MCA in 57 patients, of the M2 segment in 21, and of the M3 or M4 segment in 22. The median National Institutes of Health Stroke Scale (NIHSS) score at admission was 14, and, on average, 236 minutes elapsed from symptom onset to LIT. Forty-seven patients (47%) had an excellent outcome (mRs score 0 to 1), 21 (21%) a good outcome (mRs score 2), and 22 (22%) a poor outcome (mRs score 3 to 5). Ten patients (10%) died. Excellent or good outcome (mRs score 
2) was seen in 59% of patients with M1 or M2 and 95% of those with M3 or M4 MCA occlusions. Recanalization as seen on angiography was complete (thrombolysis in myocardial infarction [TIMI] grade 3) in 20% of patients and partial (TIMI grade 2) in 56% of patients. Age <60 years (P<0.05), low NIHSS score at admission (P<0.00001), and vessel recanalization (P=0.0004) were independently associated with excellent or good outcome and diabetes with poor outcome (P=0.002). Symptomatic cerebral hemorrhage occurred in 7 patients (7%).
Conclusions— LIT with urokinase that is administered by a single organized stroke team is safe and can be as efficacious as thrombolysis has been in large multicenter clinical trials.
Key Words: outcome • stroke, acute • thrombolytic therapy • urokinase
This article has been cited by other articles:
 |
|
 |
|
  C. Brekenfeld, P. Tinguely, G. Schroth, M. Arnold, M. El-Koussy, K. Nedeltchev, J.V. Byrne, and J. Gralla Percutaneous Transluminal Angioplasty and Stent Placement in Acute Vessel Occlusion: Evaluation of New Methods for Interventional Stroke Treatment AJNR Am. J. Neuroradiol., June 1, 2009; 30(6): 1165 - 1172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Meier, K. Nedeltchev, C. Brekenfeld, A. Galimanis, U. Fischer, O. Findling, L. Remonda, G. Schroth, H. P. Mattle, and M. Arnold Prior Statin Use, Intracranial Hemorrhage, and Outcome After Intra-Arterial Thrombolysis for Acute Ischemic Stroke Stroke, May 1, 2009; 40(5): 1729 - 1737. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Gasparotti, M. Grassi, D. Mardighian, M. Frigerio, M. Pavia, R. Liserre, M. Magoni, L. Mascaro, A. Padovani, and A. Pezzini Perfusion CT in Patients with Acute Ischemic Stroke Treated with Intra-Arterial Thrombolysis: Predictive Value of Infarct Core Size on Clinical Outcome AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 722 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Brekenfeld, G. Schroth, H. P. Mattle, D.-D. Do, L. Remonda, P. Mordasini, M. Arnold, K. Nedeltchev, N. Meier, and J. Gralla Stent Placement in Acute Cerebral Artery Occlusion: Use of a Self-Expandable Intracranial Stent for Acute Stroke Treatment Stroke, March 1, 2009; 40(3): 847 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arnold, U. Fischer, G. Schroth, K. Nedeltchev, J. Isenegger, L. Remonda, S. Windecker, C. Brekenfeld, and H. P. Mattle Intra-arterial Thrombolysis of Acute Iatrogenic Intracranial Arterial Occlusion Attributable to Neuroendovascular Procedures or Coronary Angiography Stroke, May 1, 2008; 39(5): 1491 - 1495. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Gralla, M. Burkhardt, G. Schroth, M. El-Koussy, M. Reinert, K. Nedeltchev, J. Slotboom, and C. Brekenfeld Occlusion Length Is a Crucial Determinant of Efficiency and Complication Rate in Thrombectomy for Acute Ischemic Stroke AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 247 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Mattle, M. Arnold, D. Georgiadis, C. Baumann, K. Nedeltchev, D. Benninger, L. Remonda, C. von Budingen, A. Diana, A. Pangalu, et al. Comparison of Intraarterial and Intravenous Thrombolysis for Ischemic Stroke With Hyperdense Middle Cerebral Artery Sign Stroke, February 1, 2008; 39(2): 379 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nedeltchev, B. Schwegler, T. Haefeli, C. Brekenfeld, J. Gralla, U. Fischer, M. Arnold, L. Remonda, G. Schroth, and H. P. Mattle Outcome of Stroke With Mild or Rapidly Improving Symptoms Stroke, September 1, 2007; 38(9): 2531 - 2535. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Mandava and T. A. Kent Intra-arterial therapies for acute ischemic stroke Neurology, June 12, 2007; 68(24): 2132 - 2139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arnold, L. Kappeler, K. Nedeltchev, C. Brekenfeld, U. Fischer, B. Keserue, L. Remonda, G. Schroth, and H. P. Mattle Recanalization and Outcome After Intra-Arterial Thrombolysis in Middle Cerebral Artery and Internal Carotid Artery Occlusion: Does Sex Matter? Stroke, April 1, 2007; 38(4): 1281 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Brekenfeld, L Remonda, K Nedeltchev, M Arnold, H P Mattle, U Fischer, L Kappeler, and G Schroth Symptomatic intracranial haemorrhage after intra-arterial thrombolysis in acute ischaemic stroke: assessment of 294 patients treated with urokinase J. Neurol. Neurosurg. Psychiatry, March 1, 2007; 78(3): 280 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Schulte-Altedorneburg, H. Bruckmann, G.F. Hamann, M. Mull, M. Liebetrau, W. Weber, D. Kuhne, and T.E. Mayer Ischemic and Hemorrhagic Complications after Intra-Arterial Fibrinolysis in Vertebrobasilar Occlusion AJNR Am. J. Neuroradiol., February 1, 2007; 28(2): 378 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Kim, G.A. Ford, C.S. Kidwell, S. Starkman, F. Vinuela, G.R. Duckwiler, R. Jahan, J.L. Saver, and for the UCLA Intra-Arterial Thrombolysis Investiga Intra-Arterial Thrombolysis for Acute Stroke in Patients 80 and Older: A Comparison of Results in Patients Younger than 80 Years AJNR Am. J. Neuroradiol., January 1, 2007; 28(1): 159 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Gralla, G. Schroth, L. Remonda, K. Nedeltchev, J. Slotboom, and C. Brekenfeld Mechanical Thrombectomy for Acute Ischemic Stroke: Thrombus-Device Interaction, Efficiency, and Complications In Vivo Stroke, December 1, 2006; 37(12): 3019 - 3024. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nedeltchev, U. Fischer, M. Arnold, P. Ballinari, T. Haefeli, L. Kappeler, C. Brekenfeld, L. Remonda, G. Schroth, and H. P. Mattle Long-Term Effect of Intra-Arterial Thrombolysis in Stroke Stroke, December 1, 2006; 37(12): 3002 - 3007. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Gralla, G. Schroth, L. Remonda, A. Fleischmann, J. Fandino, J. Slotboom, and C. Brekenfeld A Dedicated Animal Model for Mechanical Thrombectomy in Acute Stroke AJNR Am. J. Neuroradiol., June 1, 2006; 27(6): 1357 - 1361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Choi, B. T. Bateman, S. Mangla, R. S. Marshall, S. Prabhakaran, J. Chong, J. P. Mohr, H. Mast, and J. Pile-Spellman Endovascular Recanalization Therapy in Acute Ischemic Stroke Stroke, February 1, 2006; 37(2): 419 - 424. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Tanaka, T. Ueguchi, E. Shimosegawa, N. Sasaki, T. Johkoh, H. Nakamura, and J. Hatazawa Effect of CT Acquisition Parameters in the Detection of Subtle Hypoattenuation in Acute Cerebral Infarction: A Phantom Study AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 40 - 45. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Nedeltchev, C. Brekenfeld, L. Remonda, C. Ozdoba, D.-D. Do, M. Arnold, H. P. Mattle, and G. Schroth Internal Carotid Artery Stent Implantation in 25 Patients with Acute Stroke: Preliminary Results Radiology, December 1, 2005; 237(3): 1029 - 1037. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Khatri, J. Neff, J. P. Broderick, J. C. Khoury, J. Carrozzella, T. Tomsick, and for the IMS-I Investigators Revascularization End Points in Stroke Interventional Trials: Recanalization Versus Reperfusion in IMS-I Stroke, November 1, 2005; 36(11): 2400 - 2403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Arnold, K Nedeltchev, L Remonda, U Fischer, C Brekenfeld, B Keserue, G Schroth, and H P Mattle Recanalisation of middle cerebral artery occlusion after intra-arterial thrombolysis: different recanalisation grading systems and clinical functional outcome J. Neurol. Neurosurg. Psychiatry, October 1, 2005; 76(10): 1373 - 1376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Fischer, M. Arnold, K. Nedeltchev, C. Brekenfeld, P. Ballinari, L. Remonda, G. Schroth, and H. P. Mattle NIHSS Score and Arteriographic Findings in Acute Ischemic Stroke Stroke, October 1, 2005; 36(10): 2121 - 2125. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Alberts, R. E. Latchaw, W. R. Selman, T. Shephard, M. N. Hadley, L. M. Brass, W. Koroshetz, J. R. Marler, J. Booss, R. D. Zorowitz, et al. Recommendations for Comprehensive Stroke Centers: A Consensus Statement From the Brain Attack Coalition Stroke, July 1, 2005; 36(7): 1597 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fiehler, K. Knudsen, G. Thomalla, E. Goebell, M. Rosenkranz, C. Weiller, J. Rother, H. Zeumer, and T. Kucinski Vascular Occlusion Sites Determine Differences in Lesion Growth from Early Apparent Diffusion Coefficient Lesion to Final Infarct AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1056 - 1061. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Zaidat, A. P. Slivka, Y. Mohammad, C. Graffagnino, T. P. Smith, D. S. Enterline, G. A. Christoforidis, M. J. Alexander, D. M.D. Landis, and J. I. Suarez Intra-Arterial Thrombolytic Therapy in Peri-Coronary Angiography Ischemic Stroke Stroke, May 1, 2005; 36(5): 1083 - 1084. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Zaidat, J. I. Suarez, J. L. Sunshine, R. W. Tarr, M. J. Alexander, T. P. Smith, D. S. Enterline, W. R. Selman, and D. M. D. Landis Thrombolytic Therapy of Acute Ischemic Stroke: Correlation of Angiographic Recanalization with Clinical Outcome AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 880 - 884. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Adams, R. Adams, G. Del Zoppo, and L. B. Goldstein Guidelines for the Early Management of Patients With Ischemic Stroke: 2005 Guidelines Update A Scientific Statement From the Stroke Council of the American Heart Association/American Stroke Association Stroke, April 1, 2005; 36(4): 916 - 923. [Full Text] [PDF]
|
|
|
|
|
|
K Nedeltchev, T A der Maur, D Georgiadis, M Arnold, V Caso, H P Mattle, G Schroth, L Remonda, M Sturzenegger, U Fischer, et al. Ischaemic stroke in young adults: predictors of outcome and recurrence J. Neurol. Neurosurg. Psychiatry, February 1, 2005; 76(2): 191 - 195. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Arnold, U Koerner, L Remonda, K Nedeltchev, H P Mattle, G Schroth, M Sturzenegger, J Weber, and F Koerner Comparison of intra-arterial thrombolysis with conventional treatment in patients with acute central retinal artery occlusion J. Neurol. Neurosurg. Psychiatry, February 1, 2005; 76(2): 196 - 199. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Abboud, E Houdart, E Meseguer, and P Amarenco Stent assisted endovascular thrombolysis of internal carotid artery dissection J. Neurol. Neurosurg. Psychiatry, February 1, 2005; 76(2): 292 - 293. [Full Text] [PDF]
|
|
|
|
|
|
H. P. Mattle, L. Kappeler, M. Arnold, U. Fischer, K. Nedeltchev, L. Remonda, S. M. Jakob, and G. Schroth Blood Pressure and Vessel Recanalization in the First Hours After Ischemic Stroke Stroke, February 1, 2005; 36(2): 264 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sorimachi, Y. Fujii, N. Tsuchiya, T. Nashimoto, A. Harada, Y. Ito, and R. Tanaka Recanalization by Mechanical Embolus Disruption during Intra-Arterial Thrombolysis in the Carotid Territory AJNR Am. J. Neuroradiol., September 1, 2004; 25(8): 1391 - 1402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Arnold, K Nedeltchev, G Schroth, R W Baumgartner, L Remonda, T J Loher, F Stepper, M Sturzenegger, B Schuknecht, and H P Mattle Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis J. Neurol. Neurosurg. Psychiatry, June 1, 2004; 75(6): 857 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Berlis, H. Lutsep, S. Barnwell, A. Norbash, L. Wechsler, C. A. Jungreis, A. Woolfenden, G. Redekop, M. Hartmann, and M. Schumacher Mechanical Thrombolysis in Acute Ischemic Stroke With Endovascular Photoacoustic Recanalization Stroke, May 1, 2004; 35(5): 1112 - 1116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arnold, K. Nedeltchev, C. Brekenfeld, U. Fischer, L. Remonda, G. Schroth, and H. Mattle Outcome of Acute Stroke Patients Without Visible Occlusion on Early Arteriography Stroke, May 1, 2004; 35(5): 1135 - 1138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nakajima, K. Kimura, T. Ogata, T. Takada, M. Uchino, and K. Minematsu Relationships between Angiographic Findings and National Institutes of Health Stroke Scale Score in Cases of Hyperacute Carotid Ischemic Stroke AJNR Am. J. Neuroradiol., February 1, 2004; 25(2): 238 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Neumann-Haefelin, R. du Mesnil de Rochemont, J.B. Fiebach, A. Gass, C. Nolte, T. Kucinski, J. Rother, M. Siebler, O.C. Singer, K. Szabo, et al. Effect of Incomplete (Spontaneous and Postthrombolytic) Recanalization After Middle Cerebral Artery Occlusion: A Magnetic Resonance Imaging Study Stroke, January 1, 2004; 35(1): 109 - 114. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. G. Jovin, H. Yonas, J. M. Gebel, E. Kanal, Y. F. Chang, S. Z. Grahovac, S. Goldstein, and L. R. Wechsler The Cortical Ischemic Core and Not the Consistently Present Penumbra Is a Determinant of Clinical Outcome in Acute Middle Cerebral Artery Occlusion Stroke, October 1, 2003; 34(10): 2426 - 2433. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. R. Wechsler, R. Roberts, A. J. Furlan, R. T. Higashida, W. Dillon, H. Roberts, H. A. Rowley, L. C. Pettigrew, A. S. Callahan III, A. Bruno, et al. Factors Influencing Outcome and Treatment Effect in PROACT II Stroke, May 1, 2003; 34(5): 1224 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nedeltchev, M. Arnold, C. Brekenfeld, J. Isenegger, L. Remonda, G. Schroth, and H. P. Mattle Pre- and In-Hospital Delays From Stroke Onset to Intra-arterial Thrombolysis Stroke, May 1, 2003; 34(5): 1230 - 1234. [Abstract] [Full Text] [PDF]
|
|