Yonsei Med J.  1994 Mar;35(1):49-61. 10.3349/ymj.1994.35.1.49.

Intra-carotid thrombolytic therapy in acute ischemic stroke of carotid arterial territory

• Lee BI
• Lee BC
• Park SC
• Shon YH
• Kim DI
• Jung TS
• Suh JH

• KMID: 1381217
• DOI: http://doi.org/10.3349/ymj.1994.35.1.49

Abstract

Intra-carotid urokinase (UK) infusion in 20 patients with acute internal carotid artery (ICA) territorial ischemic stroke achieved immediate recanalization in 45% and the clinical outcome in patients with recanalization was superior to that of patients without recanalization. The procedure was most effective in patients with smaller arterial occlusions: 7 of 10 patients with MCA branch occlusions (M2 to M4) achieved recanalization compared to only 2 of 10 with distal ICA or M1 occlusions, which should be an important issue for the critical evaluation of the efficacy of thrombolytic therapy (TT). Hemorrhagic transformation was observed in 9 patients on CT scan; petechial hemorrhage in 5 and intraparenchymal hematoma formation in 4. Among 4 patients with hematoma formation, clinical deterioration was seen in 3 cases and the angiography at the immediate end of the UK infusion showed recanalization in only one patient. The average dose of UK in patients with parenchymal hematoma formation was higher than that of patients without hemorrhagic transformation (123.3 x 10(4) units vs 101 x 10(4) units). The administration of a large dose of UK, probably more than 100 x 10(4) units, and the absence of immediate recanalization seemed to increase the risk of parenchymal hematoma formation. Despite the effort of investigators, the in-hospital time delay for the TT was significant which was mainly related to the time consuming preparation for angiography especially during night. A more effective system for the earlier intervention of acute ischemic stroke needs to be developed.

Keyword

Thrombolytic therapy; Urokinase; recanalization; hemorrhagic transformation

MeSH Terms

Adult
Aged
Angiography
Brain Ischemia/*drug therapy/radiography
Carotid Artery Thrombosis/*drug therapy/radiography
Female
Human
Male
Middle Age
Support, Non-U.S. Gov't
Thrombolytic Therapy/*methods
Tomography, X-Ray Computed
Urinary Plasminogen Activator/*administration & dosage