Local Intraarterial Urokinase Thrombolysis of Acute Ischemic Stroke with or without Intravenous Abciximab: A Pilot Study

Abstract

One of the most important prognostic factors in the thrombolytic treatment of acute ischemic stroke is the time to recanalization. To shorten the recanalization time, an antiplatelet agent, abciximab (platelet glycoprotein receptor IIb/IIIa antagonist), was administered intravenously before the initiation of local intraarterial urokinase thrombolysis. The purpose of this study was to evaluate the effectiveness and safety of this combined therapy. A total of 26 patients with acute ischemic stroke (National Institutes of Health Stroke Scale score >10) were enrolled in this study. In the earlier phase of this study, conventional local intraarterial urokinase thrombolysis was performed in 16 patients (urokinase group). In the later phase, combined use of intravenous abciximab and local intraarterial urokinase thrombolysis was performed in 10 patients (urokinase + abciximab group). Recanalization rate (Thrombolysis in Myocardial Infarction grade >or=2), total amount of urokinase used, incidence of symptomatic hemorrhage, and better functional outcome rate (modified Rankin scale <or=2) were compared between the two groups with use of the Fisher exact test or Mann-Whitney U test. The recanalization rate in the urokinase + abciximab group (90%, nine of 10) was significantly higher than that in the urokinase group (43.8%, seven of 16) (P =.037). The mean amount of urokinase required for recanalization was significantly lower in the urokinase + abciximab group (828,000 IU vs 418,000 IU; P <.005). As for the incidence of symptomatic hemorrhage, no significant difference was noted between the two groups (four of 16 vs three of 10) (P = 1.0). The urokinase + abciximab group showed a trend of better functional outcome (50% vs 80%; P =.2). Combined therapy employing intravenous abciximab and local intraarterial urokinase thrombolysis showed a marked improvement in recanalization rate and showed a trend of better functional outcome. The safety of this regimen still remains to be justified with modification of the indication and regimen dosage.