Predictors of clinical improvement, angiographic recanalization, and intracranial hemorrhage after intra-arterial thrombolysis for acute ischemic stroke
Ji. Suarez et al., Predictors of clinical improvement, angiographic recanalization, and intracranial hemorrhage after intra-arterial thrombolysis for acute ischemic stroke, STROKE, 30(10), 1999, pp. 2094-2100
Background and Purpose-We sought to evaluate predictors of clinical outcome
, angiographic success, and adverse effects after intra-arterial administra
tion of urokinase for acute ischemic stroke.
Methods-We designed a Brain Attack program at University Hospitals of Cleve
land for diagnosis and treatment of patients presenting within 6 hours of o
nset of neurological deficit. Patients with ischemia referable to the carot
id circulation were treated with intra-arterial urokinase. Angiographic rec
analization was assessed at the end of medication infusion. Intracerebral h
emorrhage was investigated immediately after and 24 hours after treatment.
Stroke severity was determined, followed by long-term outcome.
Results-Fifty-four patients were treated. There was improvement of greater
than or equal to 4 points on the National Institutes of Health Stroke Scale
from presentation to 24 hours after onset in 43% of the treated patients,
and this was related to the severity of the initial deficit. Forty-eight pe
rcent of patients had a Barthel Index score of 95 to 100 at 90 days, and to
tal mortality was 24%. Cranial CT scans revealed intracerebral hemorrhage i
n 17% of patients in the first 24 hours, and these patients had more severe
deficits at presentation, Eighty-seven percent of patients received intrav
enous heparin after thrombolysis, and 9% of them developed a hemorrhage int
o infarction. Angiographic recanalization was the rule in complete occlusio
ns of the horizontal portion of the middle cerebral artery, but distal caro
tid occlusions responded less well to thrombolysis.
Conclusions-The intra-arterial route for thrombolysis allows for greater di
agnostic precision and achievement of a higher concentration of the thrombo
lytic agent in the vicinity of the clot. Disadvantages of this therapy lie
in the cost and delay. Severity of stroke and site of angiographic occlusio
n may be important predictors of successful treatment.