EARLY LOCAL INTRAARTERIAL THROMBOLYSIS FOR SEVERE MIDDLE CEREBRAL-ARTERY STROKE

Nineteen patients selected for acute hemispheric stroke, severe and st able motor impairment and angiographically proven occlusion of middle cerebral artery trunk or internal carotid artery siphon within 6 h fro m symptoms onset were treated with graded local urokinase injections u sing a superselective approach. Eleven of them (58%) displayed partial or subcomplete reperfusion after 900,000 units of urokinase. On follo w-up computed tomography, mass effect was severe in 12 patients and mo derate in 3 patients. Only 1 patient developed a brain hematoma with c linical deterioration. Good or fair outcome correlated with the presen ce of collateral blood flow (p < 0.003) and reperfusion (p < 0.007). A ll patients with collaterals demonstrated immediate recanalization. Lo cal superselective arterial thrombolysis led to a relatively high repe rfusion rate, although needing unexpectedly large doses of urokinase. The study emphasizes the central importance of leptomeningeal blood fl ow for both the likelihood of immediate reperfusion and prognosis.