Korean J Radiol.  2007 Apr;8(2):87-93. 10.3348/kjr.2007.8.2.87.

Review of the Current Status of Intra-Arterial Thrombolysis for Treating Acute Cerebral Infarction: a Retrospective Analysis of the Data from Multiple Centers in Korea

• Lee DH
• Na DG
• Ihn YK
• Kim DJ
• Kim EY
• Kim YS
• Lim SM
• Roh HG
• Sohn CH
• Stroke Study Group

• KMID: 1126831
• DOI: http://doi.org/10.3348/kjr.2007.8.2.87

Abstract

OBJECTIVE
The purpose of the study was to review the current status of intra-arterial (IA) thrombolysis in Korea by conducting a retrospective analysis of the data from multiple domestic centers. MATERIALS AND METHODS: The radiologists at each participating institution were asked to fill out case report forms on all patients who had undergone IA recanalization due to acute anterior circulation ischemia. These forms included clinical, imaging and procedure-related information. A central reader analyzed the CT/MR and angiographic results. The rates of successful recanalization, hemorrhagic transformation and functional outcome were obtained. The univariate analyses were performed together with the multivariate analysis. RESULTS: We analyzed the data from 163 patients, and they had been treated at seven institutes. The initial imaging modalities were CT for 46 patients (28%), MR for 63 (39%), and both for 54 (33%). Various mechanical treatment methods were applied together in 50% of the patients. Radiologically significant hemorrhage was noted in 20/155 patients (13%). We found various factors that influenced the recanalization rate and the occurrence of significant hemorrhagic transformations. The favorable outcome rate, reported as modified Rankin Scale < or = 2, was 40%, and the mortality rate was 11%. The factors that predicted a poor functional outcome were old age (p = 0.01), initially severe neurological symptoms (p < 0.0001), MR findings of a wide distribution of lesions (p = 0.001), involvement of the basal ganglia (p = 0.01), performance of procedures after working hours (p = 0.01), failure of recanalization (p = 0.003), contrast extravasation after the procedure (p = 0.007) and significant hemorrhagic transformation (p = 0.002). The subsequent multivariate analysis failed to show any statistically significant variable. CONCLUSION: There was a trend toward increased dependency on MR imaging during the initial evaluation and increased usage of combined pharmacologic/mechanical thrombolysis. The imaging and clinical outcome results of this study were comparable to those of the previous major thrombolytic trials.

Keyword

Brain ischemia; Brain infarction; Thrombolytic therapy

MeSH Terms

Acute Disease
Cerebral Angiography
Cerebral Infarction/diagnosis/*drug therapy
Female
Fibrinolytic Agents/*administration & dosage
Humans
Injections, Intra-Arterial
Logistic Models
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Thrombolytic Therapy/*methods/standards
Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1 Functional outcome represented as modified Rankin Scale and comparison of the current results with those of the control and treated groups of the major thrombolysis trials.

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