INTRAARTERIAL STREPTOKINASE IN ACUTE ISCHEMIC STROKE - A PILOT-STUDY

Aims: To assess the safety and efficacy of the intra-arterial administ ration of streptokinase within 24 hours of acute ischaemic stroke. Met hods: Patients who presented to the Austin Hospital casualty departmen t between 3 and 22 hours after an acute stroke were considered for the study. Eligible patients had pretreatment noncontrast computed tomogr aphic scans of the brain to exclude haemorrhage. Streptokinase (250 00 0 units) was administered directly into the common carotid artery or t he cervical portion of the internal carotid artery. Main outcome measu res: The incidence of symptomatic and asymptomatic cerebral haemorrhag e, haemorrhagic transformation of infarction, angiographic reperfusion , clinical outcome at seven to 10 days and the frequency of other comp lications. Results: Thirteen patients were treated over a 16-month per iod. Major clinical improvement occurred in five patients (39%) at 48 hours. This was associated with angiographically demonstrated recanali sation of a middle cerebral artery occlusion in two patients and parti al recanalisation in two others. Significant hypotension in two patien ts required therapy to be stopped. In five other cases mild hypotensio n developed but the streptokinase infusion was completed. Haemorrhagic transformation of the infarct occurred in four patients without clini cal deterioration. Conclusion: Intra-arterial administration of strept okinase is safe in selected patients with acute ischaemic stroke. The theoretical benefit of an increased local thrombolytic effect and redu ced systemic complications, compared with the use of higher intravenou s doses, justifies a randomised clinical trial. If therapies such as t his are to be successful, rapid referral to an appropriate centre is n ecessary.