Document Detail


Simple microwire and microcatheter mechanical thrombolysis with adjuvant intraarterial urokinase for treatment of hyperacute ischemic stroke patients.
MedLine Citation:
PMID:  18365826     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Dong Joon Kim; Dong Ik Kim; Joon Soo Byun; Jin Young Jung; Sang Hyun Suh; Eung Yeop Kim; Kyung-Yul Lee; Ji Hoe Heo
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta radiologica (Stockholm, Sweden : 1987)     Volume:  49     ISSN:  1600-0455     ISO Abbreviation:  Acta Radiol     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-27     Completed Date:  2008-04-22     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8706123     Medline TA:  Acta Radiol     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  351-7     Citation Subset:  IM    
Affiliation:
Department of Radiology, Yonsei University College of Medicine, Seoul, Korea. dikim@yumc.yonsei.ac.kr
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Catheterization / instrumentation*
Chemotherapy, Adjuvant
Combined Modality Therapy / adverse effects,  instrumentation,  methods
Feasibility Studies
Female
Fibrinolytic Agents / administration & dosage,  adverse effects,  therapeutic use*
Follow-Up Studies
Humans
Infarction, Middle Cerebral Artery / drug therapy*
Injections, Intra-Arterial
Male
Middle Aged
Prospective Studies
Thrombolytic Therapy / adverse effects,  instrumentation*,  methods
Treatment Outcome
Urokinase-Type Plasminogen Activator / administration & dosage,  adverse effects,  therapeutic use*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.73/Urokinase-Type Plasminogen Activator
Comments/Corrections
Comment In:
Acta Radiol. 2008 Apr;49(3):249   [PMID:  18365806 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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