Successful Intra-arterial Thrombolysis Research Articles

Successful Intra-Arterial Thrombolysis and Stenting in an Acute Ischemic Stroke Patient Caused by Anterior Cerebral Artery (ACA) Dissection with Occlusion

Successful Intra-Arterial Thrombolysis and Stenting in an Acute Ischemic Stroke Patient Caused by Anterior Cerebral Artery (ACA) Dissection with Occlusion

FT08. Results of Open or Endovascular Management of Thrombosed Popliteal Artery Aneurysms Following Successful Intra-arterial Thrombolysis in a Multicentric Registry

FT08. Results of Open or Endovascular Management of Thrombosed Popliteal Artery Aneurysms Following Successful Intra-arterial Thrombolysis in a Multicentric Registry

Successful Intra-arterial Thrombolysis in a Patient with an Intracranial Meningioma

Alteplase (recombinant tissue plasminogen activator [rt-PA]) label approval by theFood and Drug Administration remarks the contraindication of its use with known intracranial neoplasm because of potential bleeding complications. Despite this concern, the real risk of intracerebral bleeding in patients with intracranial neoplasms treated with rt-PA is unknown, and there are few reports of thrombolysis in patients with brain tumors. We report a case of a 78-year-old man who was seen in our emergency department within 2hours from sudden onset of aphasia, right-sided hemiplegia, hypoesthesia, and homonymous hemianopsia. The National Institutes of Health Stroke Scale (NIHSS) score at admission was 20. Intra-arterial thrombolysis was performed with administration of .3mg/kg of alteplase combined with mechanical thrombectomy. At discharge, his NIHSS score was 1, and after 90days, his modified Rankin score was 1. To our knowledge, this is the first reportof intra-arterial thrombolysis in a patient with acute ischemic stroke with an intracranial tumor.

Balloon-Expandable Stent Placement in Patients with Immediate Reocclusion after Initial Successful Thrombolysis of Acute Middle Cerebral Arterial Obstruction

We present the results of our approach for treating 12 consecutive cases of acute middle cerebral artery (MCA) stroke by performing balloon-expandable stent (BES) placement after immediate reocclusion due to the underlying stenosis after intra-arterial thrombolysis (IAT). We retrospectively reviewed the clinical outcomes of 12 patients with acute MCA stroke who underwent recanalization by BES placement in an underlying stenosis after IAT. The time to treatment, urokinase dose, duration of the procedure, recanalization rates and symptomatic hemorrhage were analyzed. Clinical outcome measures were assessed on admission and at discharge (the National Institutes of Health stroke scores [NIHSS]) as well as three months after treatment (modified Rankin scales [mRS]). The median NIHSS score on admission was 8.6. Four patients received IV rtPA. The median time from symptom onset to IAT was 236 minutes and the median duration of IAT was 62 minutes. The median dose of urokinase was 140,000 units. Initial recanalization after stent deployment (thrombolysis in cerebral ischemia attack grade of II or III) was achieved in all patients. Two patients died in the hospital due to aspiration pneumonia during medical management. In two patients, in-stent reocclusion occurred within 48 hours after stent deployment. At discharge, the median NIHSS score in ten patients (including the patients with reobstruction) was 2.4. The three-month outcome was excellent (mRS, 0-1) in eight patients. In this study, BES deployment was safe and effective in patients with an immediately reoccluded MCA after successful IAT.

Successful Intra-arterial Thrombolysis in a Patient with Perioperative Stroke after Open Heart Surgery

To present the case of a 54-year-old male who suffered from sudden-onset motor aphasia and right-sided weakness on the 14th inpatient day after open-heart surgery for mitral valve replacement. Acute left middle cerebral artery (MCA) occlusion of the M1 segment was found on contrast computed tomographic angiogram of the head. A history of recent major surgery and old intracerebral hemorrhage excluded the patient from intravenous thrombolytic (IVT) therapy. Highly selective local intra-arterial thrombolytic (IAT) therapy was selected for its lower risk of systemic bleeding complication, since symptom onset had occurred 4 hours earlier in this patient. The occluded MCA was completely recanalized after administration of 1, 250, 000 units of intra-arterial urokinase. The patient•s neurological function resumed quickly without early or delayed hemorrhagic complication. The highly selective local IAT may be an alternative therapy in patients with perioperative acute ischemic stroke who are not eligible for IVT therapy.

Successful intra-arterial thrombolysis beyond the accepted 6-hour time window in two young patients

Two young women with ischemic stroke successfully underwent intra-arterial thrombolysis (IAT) 10 and 11 h, respectively after stroke onset. A 23-year-old (case 1) and a 22-year-old woman (case 2) who developed severe neurological deficits (NIHSS 20 and 13, respectively) were presented to our hospital 9 h after onset of the symptoms. In case 1 a CT angiography (CTA) revealed an occlusion of the left middle cerebral artery (MCA) and in case 2 CTA showed a large embolus at the left carotid bifurcation, almost entirely occluding the internal carotid artery. We decided to apply IAT beyond the generally accepted 6-hour time window. Case 1 was treated with 2 mg rtPA administered locally in the occluded MCA followed by 70 mg rtPA (1 mg/min) and case 2 was treated with 100,000 IU urokinase in the left common carotid artery followed by 200,000 IU during 2 h and 10 mg abciximab. In case 1 IAT resulted in complete recanalisation of the MCA within 3 h and complete resolution of symptoms in the following six weeks. In case 2 IAT resulted in an initial 50% reduction of the thrombus. After nine days CTA showed complete lysis and the patient had completely recovered. Both patients suffered from Anti-Phospholipid-Syndrome. The results show that IAT may be beneficial to young patients with a severe stroke, even beyond the 6-hour time window.

Life-Threatening Anaphylactoid Reaction in an Acute Ischemic Stroke Patient With Intravenous rt-PA Thrombolysis, Followed by Successful Intra-Arterial Thrombolysis

An anaphylactoid reaction to recombinant tissue plasminogen activator (rt-PA) is an uncommon but fatal complication. A 39-year-old man was admitted within 1 hour of the onset of a right hemispheric stroke. He was not taking any specific medication, including angiotensin-converting enzyme (ACE) inhibitors. A systemic anaphylactoid reaction developed immediately after rt-PA infusion. However, the symptoms were improved after treatment with a steroid and antihistamine. Subsequent intra-arterial thrombolytic therapy resulted in complete recanalization and clinical improvement. To our knowledge, this is the first report of a life-threatening anaphylactoid reaction after rt-PA treatment followed by successful intra-arterial thrombolytic therapy in a patient who had not taken an ACE inhibitor.

Successful Intra-Arterial Thrombolysis for Acute Ischemic Stroke in the Immediate Postpartum Period: Case Report

Stroke in pregnancy and the puerperium is a rare but potentially devastating event. We present the case of a previously healthy woman who underwent a cesarean delivery and experienced a middle cerebral artery thrombosis in the immediate postpartum period that was subsequently lysed with intra-arterial urokinase. The patient made a complete neurologic recovery. To the best of our knowledge, this is the first reported case of successful intra-arterial thrombolysis for ischemic stroke in the postpartum period.

Interventionelle endovaskuläre Therapie (Stentimplantation) bei residuellen Stenosen nach Lyse der A. basilaris

Despite the introduction of local thrombolytic therapy, there is still a very high mortality rate in basilar thrombosis. We report three cases of successful intra-arterial thrombolysis of acute basilar artery occlusion and consecutive interventional endovascular therapy. In all cases, the acute thrombosis of the basilar artery probably developed from preexisting atherosclerotic stenoses. The clinical outcomes were excellent. We discuss early consecutive stenting as a possible therapeutic option in cases of residual stenosis after successful intra-arterial lysis of basilar artery occlusion.

Successful intra-arterial thrombolysis of isolated deep cerebral venous thrombosis

Cerebral venous thrombosis is a rare cerebrovascular disorder with variable outcome. The involvement of the deep cerebral venous system is often associated with a poor prognosis.

Morphological abnormalities revealed after successful intra-arterial thrombolysis of infra-inguinal native arteries and bypasses.

To characterise morphological abnormalities depicted after successful intra-arterial thrombolysis; to determine whether these differed in infra-inguinal native arteries and bypasses; and to evaluate whether balloon angioplasty was an appropriate treatment of stenoses in the acute phase after thrombolysis. Patient records, radiology records, and angiograms from 47 patients with acute or subacute occlusions of infra-inguinal arteries (n = 21) or bypasses (n = 26) successfully treated with continuous intra-arterial infusion of streptokinase, urokinase or tissue plasminogen activator were retrospectively reviewed. Angiographic morphological abnormalities were depicted in 18 of 21 arteries (86%) and in 23 of 26 bypasses (88%), the most common abnormality being stenoses. Haemodynamically significant stenoses were found in 15 arteries (71%) and 18 bypasses (69%). The majority of the stenoses were successfully treated with balloon angioplasty, both in native arteries (12/15; 80%) and in bypasses (14/18; 78%). Morphological abnormalities are most often shown after successful intra-arterial thrombolysis in arteries, autogenous and non-autogenous bypasses. In all types of conduits, stenoses are the most commonly revealed lesion, which in the majority of cases can be treated with balloon angioplasty. Short-term outcome after catheter-directed thrombolysis and angioplasty seems fair.

Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography.

This study investigates retrospectively, in selected patients, the ischemic outcome (reversible ischemia, infarction, and hemorrhage) and neurologic outcome of acute stroke treated with intra-arterial thrombolysis and the predictive value of pretreatment single-photon emission-computed tomography (SPECT). Thirty patients with complete recanalization within 12 hours were analyzed. The extent of ischemia was outlined on SPECT, and two CBF parameters were calculated: the ratio of ischemic regional activity to CBF in the cerebellum and the asymmetry index. Reversible ischemia, infarction, and hemorrhage were identified by comparing SPECT and follow-up computed tomography. Nine patients (30%) had no or small infarction, 14 (47%) had medium or large infarction, and seven (23%) had hemorrhage. Forty-two lesions were identified (22 reversible ischemia, 13 infarction, and 7 hemorrhage). Duration of ischemia, urokinase dose, disease type, and occlusion site were nonsignificant factors, whereas neurologic outcome and CBF parameters were significant among the three patient groups and three types of ischemic lesions. Ischemic tissue with CBF greater than 55% of cerebellar flow still may be salvageable, even with treatment initiated 6 hours after onset of symptoms. Ischemic tissue with CBF greater than 35% of cerebellar flow still may be salvageable with early treatment (less than 5 hours). Ischemic tissue with with CBF less than 35% of cerebellar flow may be at risk for hemorrhage within the critical time window. Pretreatment SPECT can provide useful parameters to increase the efficacy of thrombolysis by reducing hemorrhagic complications and improving neurologic outcome.

Morphological Abnormalities Revealed after Successful Intra-Arterial Thrombolysis of Infra-Inguinal Native Arteries and Bypasses

Morphological Abnormalities Revealed after Successful Intra-Arterial Thrombolysis of Infra-Inguinal Native Arteries and Bypasses

Factors predicting the outcome of intraarterial thrombolysis in peripheral arterial and graft occlusions.

To determine the association between successful intraarterial thrombolysis and the following factors: sex, age, symptoms, duration of symptoms, length of occlusion, conduit type, runoff, and catheter localization. Forty-six patients with acute or subacute occlusions of peripheral native arteries and grafts were treated with continuous intraarterial infusion of streptokinase or urokinase. A univariate chi-square test and logistic regression analysis were used. Successful lysis was achieved in 27 of 46 patients (59%). The logistic regression analysis revealed a significant association between successful thrombolysis and good runoff (p < 0.01). A catheter position above the occlusion resulted in lysis in only one of 11 patients. The variables rest pain and claudication were slightly significant (p = 0.07). None of the other variables were significant, but a trend toward a separate effect of duration of occlusion was found. Good runoff and intrathrombotic infusion are virtual necessities in obtaining a positive immediate outcome in peripheral arterial and graft occlusions. In our study, other factors were less important.

Limitations to the widespread usage of low-dose intra-arterial thrombolysis

Despite encouraging results, intra-arterial thrombolysis (IAT) has not been readily accepted by British surgeons. In an attempt to clarify the reasons for this we sent a postal questionnaire to surgeons with a vascular interest, asking them to define their present attitude towards IAT. Subsequently, we re-analysed our own clinical data in the light of the answers received. In all 134 surgeons (58%) replied to the questionnaire; 48 (38%) never used IAT and 56 (45%) used it only occasionally. When stated, the main reasons for this limited use were the doubts about efficacy (45%) and lack of radiological support (47%). From November 1988 to August 1990 we used IAT for 82 occlusions (streptokinase 74, rt-PA8). Lysis was achieved in 82% of cases when treatment was started within 1 week of symptoms starting, and 62% with symptoms of longer duration. Following successful IAT no further treatment was required in 44% of cases, reconstruction was needed in 26% and angioplasty in 23%, one major amputation was performed. Unsuccessful lysis resulted in reconstruction in 40% of cases. Overall, the limb salvage rate was 89%. Major complications occurred in six cases. One patient sustained a fatal CVA and five bled from the catheter insertion site. Two of these patients required an emergency operation and one other, who had an angioplasty immediately following lysis, died. Minor complications included local haematoma formation (16), catheter problems (6), and allergic reactions (2). After insertion of the perfusing catheter, angiograms (median 4, maximum 10) were performed at intervals, with repositioning of the catheter if necessary, until lysis was complete.(ABSTRACT TRUNCATED AT 250 WORDS)