Intra-Arterial Thrombolysis in 100 Patients With Acute Stroke Due to Middle Cerebral Artery Occlusion

Abstract

Background and Purpose — 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. Methods — 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. Results — Angiography showed occlusion of the M 1 segment of the MCA in 57 patients, of the M 2 segment in 21, and of the M 3 or M 4 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 1 or M 2 and 95% of those with M 3 or M 4 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 ( P <0.05), low NIHSS score at admission ( P <0.00001), and vessel recanalization ( P =0.0004) were independently associated with excellent or good outcome and diabetes with poor outcome ( P =0.002). Symptomatic cerebral hemorrhage occurred in 7 patients (7%). Conclusions — 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.