American Journal of Neuroradiology 23:277-281, February 2002
© 2002 American Society of Neuroradiology
INTERVENTIONAL
Combined Direct Percutaneous Transluminal Angioplasty and Low-Dose Native Tissue Plasminogen Activator Therapy for Acute Embolic Middle Cerebral Artery Trunk Occlusion
a Department of Neurosurgery, Junwakai Memorial Hospital, Miyazaki, Japan
b Miyazaki Medical College, Miyazaki, Japan
Address reprint requests to Takumi Yoneyama, MD, Department of Neurosurgery, Junwakai Memorial Hospital, 1119, Komatsu, Miyazaki 880-2112, Japan
BACKGROUND AND PURPOSE: In embolic middle cerebral artery (MCA) trunk occlusion, recanalization with direct percutaneous transluminal angioplasty (PTA) may be preferable to time-consuming thrombolysis. However, distal embolization with small crushed fragments is a complication of direct PTA. We prospectively evaluated combined direct PTA and low-dose native tissue plasminogen activator (t-PA) therapy for acute embolic MCA trunk occlusion.
METHODS: Fifteen patients underwent direct PTA. The embolus was successfully crushed in 12, who received subsequent native t-PA infusion. Direct PTA was performed with a balloon catheter, which was advanced into the occlusion site and inflated several times until recanalization was established. After PTA, 7.2 mg of native t-PA in 100 mL of isotonic sodium chloride solution was infused for 30 minutes. Neurologic status was evaluated at admission and immediately and 1 month after treatment. In all patients, follow-up CT was performed within 24 hours and 3–7 days after onset, and follow-up MR imaging, 1 month after onset.
RESULTS: Direct PTA failed to crush the embolus in three of 15 patients; these three had no clinical improvement. In 11 of 12 patients, combined therapy was successful, with no technical complication. Although no symptomatic intracerebral hemorrhage occurred, one patient had a small hematoma. All patients with successful recanalization had marked clinical improvement. Although angiograms showed distal embolizations in 10, cortical infarctions were confirmed in only three at follow-up.
CONCLUSION: Combined direct PTA and IV low-dose native t-PA therapy may be a safe alternative to thrombolytic therapy in some patients with embolic MCA trunk occlusion.
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