Weight-Adjusted and Activated Clotting Time–Guided Heparinization Might Reduce the Postprocedural Hemorrhage in Percutaneous Transluminal Angioplasty for Acute Middle Cerebral Artery Occlusion

Abstract

To the Editor: We were impressed by the novel approach to treat acute ischemic stroke due to middle cerebral artery (MCA) occlusion proposed by Dr Nakano and coworkers.1 Instead of intravenous thrombolytic therapy, they had treated such disease with intra-arterial reperfusion therapy in 70 consecutive patients, 34 of whom with direct percutaneous transluminal angioplasty (PTA) over the infarct-related artery (IRA) and the remaining 36 with thrombolytic therapy alone. They found that the PTA group had not only higher IRA patency rate (91.2% versus 63.9%, P 24 hours) contrast medium extravasation or minor bleeding after the procedure. Consequently, the authors proposed that the direct PTA is an effective alternative to intra-arterial thrombolysis for MCA trunk occlusion. To our surprise is the principle of anticoagulant dosage the authors used, which is quite different from that used in conventional percutaneous coronary intervention …