INTRATHROMBUS ADMINISTRATION OF TISSUE-PLASMINOGEN ACTIVATOR IN ACUTECEREBROVASCULAR OCCLUSION

Intraarterial thrombolysis for acute cerebrovascular occlusion has ach ieved recanalization at a 50-90% rate. Clinical outcome has been unpre dictable. The authors sought to test the hypothesis that intrathrombus administration of recombinant tissue plasminogen activator (rt-PA) wo uld improve recanalization rate and to assess the possibility that cli nical outcome would be predicted by the extent of collateral flow. Sev en patients with acute cerebrovascular occlusion (less than six hours in 6, twenty-four hours in 1) were treated with intrathrombus rt-PA at 1 mg/minute. Examinations were scored on a five-point motor scale. Co llateral flow was assessed angiographically. Vessels recanalized in 5 patients, 3 of whom had good outcomes. Vessels failed to recanalize in 2 patients, 1 of whom had good outcome. Good collateral flow was evid ent in all 4 patients with good outcome and in none of those with poor outcome. Intrathrombus administration of rt-PA is technically feasibl e. Favorable clinical outcome is more likely in the presence of good c ollateral flow. In the absence of good collateral flow, ultra-early in tervention may be necessary.