Predictors of clinical improvement, angiographic recanalization, and intracranial hemorrhage after intra-arterial thrombolysis for acute ischemic stroke

Citation
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
Citations number
27
Categorie Soggetti
Neurology,"Cardiovascular & Hematology Research
Journal title
STROKE
ISSN journal
00392499 → ACNP
Volume
30
Issue
10
Year of publication
1999
Pages
2094 - 2100
Database
ISI
SICI code
0039-2499(199910)30:10<2094:POCIAR>2.0.ZU;2-S
Abstract
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.