Superselective Local Infusion of Urokinase for Acute Ischemic Stroke in the Carotid Artery Territory

ABSTRACT

BACKGROUND: It has been known that superselective local infusion of urokinase (UK) for an acute ischemic stroke in the carotid artery territories (CAT) is associated with a high incidence of complete recanalization (RCN) of the occluded arteries and good clinical outcomes without excess risk of hemorrhagic transformation. We intended to evaluate the clinical outcomes of patients who had experienced an acute ischemic stroke in CAT who underwent superselective local infusions of UK and to find clinical variables affecting complete RCN or clinical outcomes. METHODS: Consecutively, 18 patients with acute ischemic strokes in CAT (12 in MCA occlusion and 6 in ICA) were enrolled in this study. All patients underwent superselective local infusion of UK and were assessed degree of to the RCN with angiographic findings and clinical outcomes using a modified Barthel index and a modified NIH stroke scale score prospectively. RESULTS: A complete RCN was achieved in 12 patients (67%), partial RCN in 3 patients (17%) and no RCN in 3 other patients (17%). A complete RCN seems to have been affected by the site of the occlusion (10 in MCA occlusion and 2 in ICA), and the type of ischemic stroke (10 in embolic and 2 in thrombotic). The degree of leptomeningeal collateral circulation(LCC) also affected the degree of the RCN; patients with thrombotic stroke (n=5 ; 2 in good LCC and 3 in poor), a complete RCN was achieved only in patients with good LCC. The clinical outcomes of the patients with complete RCN were significantly superior to the patients with partial or no RCN. Hemorrhagic transformation was observed in 4 patients (22%), but 2 patients did not affect clinical outcome. Three patients died(17%). CONCLUSION: Considering the natural outcome and quality of life of the patients with ischemic stroke in CAT, our results suggest that superselective local infusion of UK as a treatment modality for acute major ischemic stroke is a effective method, as long as adequate clinical variables are fulfilled.