Simple microwire and microcatheter mechanical thrombolysis with adjuvant intraarterial urokinase for treatment of hyperacute ischemic stroke patients
- Authors
- Kim, Dong Joon; Kim, Dong Ik; Byun, Jun Su; Jung, Jin Young; Suh, Sang Hyun; Kim, Eung Yeop; Lee, Kyung-Yul; Heo, Ji Hoe
- Issue Date
- 2008
- Publisher
- SAGE PUBLICATIONS LTD
- Keywords
- CNS; interventional; ischemia/infarction; thrombolysis
- Citation
- ACTA RADIOLOGICA, v.49, no.3, pp 351 - 357
- Pages
- 7
- Journal Title
- ACTA RADIOLOGICA
- Volume
- 49
- Number
- 3
- Start Page
- 351
- End Page
- 357
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/41974
- DOI
- 10.1080/02841850701819143
- ISSN
- 0284-1851
1600-0455
- Abstract
- Background: Mechanical thrombolysis may effectively enhance the efficacy of thrombolysis for hyperacute ischemic stroke patients. Purpose: To assess the feasibility and results of simple mechanical-based thrombolysis using microwire and microcatheter with adjuvant low-dose intraarterial (i.a.) urokinase (UK) for the treatment of hyperacute ischemic stroke. Material and Methods: Nineteen consecutive patients with hyperacute proximal middle cerebral artery (MCA) occlusions treated by a standardized protocol using microwire and microcatheter for mechanical thrombus disruption with adjuvant i.a. UK were reviewed. Simple to-and-fro passages through the clot with the microwire and microcatheter followed by disruptions by a J- or pigtail-shaped wire tip with alternating small-dose injections of UK distal, within, and proximal to the clot were performed. The recanalization rates, post-thrombolysis hemorrhage, and clinical outcome (baseline and discharge National Institute of Health Stroke Scale [NIHSS], mortality, 3-month modified Rankin scale [mRS]) were evaluated. Results: Recanalization was achieved in 18 of 19 patients (94.7%). The mean UK dose was 375,789 IU (range 130,000-580,000 IU). Two patients (10.5%) developed symptomatic hemorrhage. One of the hemorrhages included a patient who developed subarachnoid hemorrhage. Mortality rate was 15.8% (n=3). The median baseline NIHSS scores showed improvement from 17 to 10 at presentation and discharge, respectively. At three months, good outcome was noted in 11 of 19 patients (57.9%, mRS 0-2). Conclusion: Simple mechanical-based thrombolysis using microwire and microcatheter with adjuvant low-dose i.a. UK is safe and effective in achieving recanalization with good long-term outcome.
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