Simple microwire and microcatheter mechanical thrombolysis with adjuvant intraarterial urokinase for treatment of hyperacute ischemic stroke patients

Abstract

Mechanical thrombolysis may effectively enhance the efficacy of thrombolysis for hyperacute ischemic stroke patients. 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. 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. 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). 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.