Local intra-arterial thrombolysis for acute ischémie stroke

Our purpose is to assess the efficacy of local intra-arterial thrombolysis (LIT) in patients with acute major cerebral artery occlusion. Sixty-three patients were treated with intra-arterial tissue plasminogen activator (t-PA) or urokinase (UK). First, we analyzed in 20 patients, 11 using t-PA and nine UK. The mean time to treatment from the onset of symptoms was 4 h in the t-PA group, 3.9 h in the UK group. The recanalization rate was eight of 11 patients with t-PA (72.7%), and six of nine patients with UK (66.7%). Seven of 11 patients (63.6%) with t-PA and five of nine patients (55.6%) with UK experienced favorable outcomes (good recovery or moderate disability). The difference of the effect between t-PA and UK was not confirmed. Second, we performed LIT in 24 patients with cardioembolic stroke and 19 patients with atherosclerotic stroke. In the cardioembolic group, 17 of 24 patients (70.8%) had successful recanalization, and 12 of 24 patients (50.0%) had good outcome. In the atherosclerotic group, 12 of 19 patients (63.2%) had successful recanalization, six of 19 patients (31.6%) had a good outcome. Coma at presentation associated with a poor outcome. We consider that the LIT for the acute ischémie stroke is an effective treatment, although it is necessary to attempt a direct angioplasty, particularly in the patients with atherosclerotic stroke, if recanalization was insufficient or not achieved.