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

 Kim DJ  ;  Kim DI  ;  Byun JS  ;  Jung JY  ;  Suh SH  ;  Kim EY  ;  Lee KY  ;  Heo JH 
 ACTA RADIOLOGICA, Vol.49(3) : 351-357, 2008 
Journal Title
Issue Date
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Catheterization/instrumentation* ; Chemotherapy, Adjuvant ; Combined Modality Therapy/adverse effects ; Combined Modality Therapy/instrumentation ; Combined Modality Therapy/methods ; Feasibility Studies ; Female ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/adverse effects ; Fibrinolytic Agents/therapeutic use* ; Follow-Up Studies ; Humans ; Infarction, Middle Cerebral Artery/drug therapy* ; Injections, Intra-Arterial ; Male ; Middle Aged ; Prospective Studies ; Thrombolytic Therapy/adverse effects ; Thrombolytic Therapy/instrumentation* ; Thrombolytic Therapy/methods ; Treatment Outcome ; Urokinase-Type Plasminogen Activator/administration & dosage ; Urokinase-Type Plasminogen Activator/adverse effects ; Urokinase-Type Plasminogen Activator/therapeutic use*
CNS, interventional ; ischemia/infarction ; thrombolysis
BACKGROUND: Mechanical thrombolysis may effectively enhance the efficacy of thrombolysis for hyperacute ischemic stroke patients.

PURPOSE: 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.

MATERIAL AND METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Eung Yeop(김응엽)
Byun, Joon Soo(변준수)
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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