Local intra-arterial thrombolytic therapy for patients with acute ischemic stroke

Background: Acute thrombolysis for ischemic stroke has been proposed to help some suitable patients. We investigated the application of local intra-arterial thrombolytic therapy to patients with ischemic stroke in different territories of vascular occlusion. Methods: Ten patients with ischemic stroke, five with middle cerebral artery (MCA) occlusion, three with internal carotid artery (ICA) occlusion, and two with basilar artery (BA) occlusion, were treated by local intra-arterial infusion of urokinase. The end-point was at either reaching the maximal dosage of 1.5 MIU urokinase, early recanalization or suspicion of the occurrence of complications. Stroke scales were used to evaluate their clinical outcomes at the onset, and 7, 30 and 90 days after treatment. Results: The mean age was 59.4±12.2 (range 37 to 73) years; median baseline NIH Stroke Scale was 18.5 ±6.8 (range 8 to 30). Four of five patients with MCA occlusion had good recanalization and one had incomplete recanalization. Two patients with BA occlusion showed good recanalization and improvement of neurological deficits. In contrast, all the patients with ICA occlusion did not show recanalization and the clinical outcomes were poor. Four patients (three with MCA occlusion and one with BA occlusion) had favorable outcomes. Three patients had mild to moderate intracranial hemorrhage. Two patients died of acute myocardial infarction and symptomatic cerebral mass effect with tentorial herniation. Conclusions: Our results showed that local intra-arterial thrombolysis to treat some acute ischemic stroke due to MCA or BA occlusion might have fewer complications and better outcome than those with ICA occlusion.