Beschreibung:
<jats:p>
<jats:bold>
<jats:italic>
<jats:bold>
<jats:italic>Background and Purpose</jats:italic>
</jats:bold>
—
</jats:italic>
</jats:bold>
The purpose of this study was to evaluate the safety and efficacy of local intra-arterial thrombolysis (LIT) using urokinase in patients with acute stroke due to middle cerebral artery (MCA) occlusion.
</jats:p>
<jats:p>
<jats:bold>
<jats:italic>
<jats:bold>
<jats:italic>Methods</jats:italic>
</jats:bold>
—
</jats:italic>
</jats:bold>
We analyzed clinical and radiological findings and functional outcome 3 months after LIT with urokinase of 100 consecutive patients. To measure outcome, the modified Rankin scale (mRs) score was used.
</jats:p>
<jats:p>
<jats:bold>
<jats:italic>
<jats:bold>
<jats:italic>Results</jats:italic>
</jats:bold>
—
</jats:italic>
</jats:bold>
Angiography showed occlusion of the M
<jats:sub>1</jats:sub>
segment of the MCA in 57 patients, of the M
<jats:sub>2</jats:sub>
segment in 21, and of the M
<jats:sub>3</jats:sub>
or M
<jats:sub>4</jats:sub>
segment in 22. The median National Institutes of Health Stroke Scale (NIHSS) score at admission was 14, and, on average, 236 minutes elapsed from symptom onset to LIT. Forty-seven patients (47%) had an excellent outcome (mRs score 0 to 1), 21 (21%) a good outcome (mRs score 2), and 22 (22%) a poor outcome (mRs score 3 to 5). Ten patients (10%) died. Excellent or good outcome (mRs score ≤2) was seen in 59% of patients with M
<jats:sub>1</jats:sub>
or M
<jats:sub>2</jats:sub>
and 95% of those with M
<jats:sub>3</jats:sub>
or M
<jats:sub>4</jats:sub>
MCA occlusions. Recanalization as seen on angiography was complete (thrombolysis in myocardial infarction [TIMI] grade 3) in 20% of patients and partial (TIMI grade 2) in 56% of patients. Age <60 years (
<jats:italic>P</jats:italic>
<0.05), low NIHSS score at admission (
<jats:italic>P</jats:italic>
<0.00001), and vessel recanalization (
<jats:italic>P</jats:italic>
=0.0004) were independently associated with excellent or good outcome and diabetes with poor outcome (
<jats:italic>P</jats:italic>
=0.002). Symptomatic cerebral hemorrhage occurred in 7 patients (7%).
</jats:p>
<jats:p>
<jats:bold>
<jats:italic>
<jats:bold>
<jats:italic>Conclusions</jats:italic>
</jats:bold>
—
</jats:italic>
</jats:bold>
LIT with urokinase that is administered by a single organized stroke team is safe and can be as efficacious as thrombolysis has been in large multicenter clinical trials.
</jats:p>