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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:513-517, March 2007
© 2007 American Society of Neuroradiology

INTERVENTIONAL

Balloon Catheter Disruption of Middle Cerebral Artery Thrombus in Conjunction with Thrombolysis for the Treatment of Acute Middle Cerebral Artery Embolism

I. Ikushima^a, H. Ohta^b, T. Hirai^c, K. Yokogami^b, D. Miyahara^b, N. Maeda^a and Y. Yamashita^c

^a Department of Radiology, Miyakonojo Medical Association Hospital, Miyakonojo, Japan
^b Department of Neurosurgery, Miyakonojo Medical Association Hospital, Miyakonojo, Japan
^c Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan

Please address correspondence to Ichiro Ikushima, Department of Radiology, Miyakonojo Medical Association Hospital, Miyakonojo, 5822-three Oiwadacho, Miyakonojo 885-0062 Japan; e-mail: iku-i{at}fk.enjoy.ne.jp

BACKGROUND AND PURPOSE: The goal of this study was to prospectively assess the feasibility, safety, and efficacy of balloon disruption of the middle cerebral artery (MCA) by using a deflated balloon catheter combined with an intra-arterial thrombolysis for the treatment of acute ischemic stroke.

MATERIALS AND METHODS: Seven consecutive patients with clinical findings of acute major-vessel stroke met our criteria and underwent balloon disruption of an MCA thrombus with a deflated balloon catheter. The balloon disruption was performed with a low-profile microballoon catheter. The microballoon was inflated in the distal carotid artery and then deflated and advanced just distal to the occlusion site in the MCA. Thereafter, an intra-arterial thrombolysis of the MCA was applied. The maximum time from the onset of symptoms to the start of treatment and maximum dosage of urokinase was 6 hours and 600,000 U. The outcome was classified as good for a modified Rankin Scale (mRS) score of 0 or 1, moderate for a score of 2 or 3, and poor for a score of 4 or 5.

RESULTS: Complete recanalization was achieved in 5 patients and partial recanalization in 3. Three patients recovered to an mRS score of 0 or 1; 3, to scores of 2 or 3; and 1, to a score of 4. No patients died. There was no major intracerebral hemorrhage.

CONCLUSIONS: The penetration of the MCA with a deflated balloon catheter combined with an intra-arterial thrombolysis may be a safe and effective treatment for acute ischemic stroke.

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