RT Journal Article SR Electronic T1 Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 175 OP 179 DO 10.3174/ajnr.A2722 VO 33 IS 1 A1 J.S. Lee A1 J.M. Hong A1 E.J. Kim A1 D.H. Shin A1 I.S. Joo A1 Y.C. Lim A1 S.H. Suh A1 S.Y. Kim YR 2012 UL http://www.ajnr.org/content/33/1/175.abstract AB BACKGROUND AND PURPOSE: Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol. MATERIALS AND METHODS: Sixteen consecutive patients with acute ischemic stroke due to CTO who had combined IV and IA or a single IA thrombolytic treatment were enrolled. The baseline characteristics and prognosis were described. The patients who did and did not develop a PH shortly after treatment were compared. RESULTS: The mean age was 66.4 years, and the median initial NIHSS score was 17. The median dose of IA urokinase was 320,000 U, and recanalization (TICI grade II-III) was achieved in 12 patients (75%). However, 5 patients died and 10 patients had poor prognosis with mRS 5–6 at discharge. Six patients (37.5%) with a PH had a higher NIHSS score 1 day after treatment (26.7 versus 13.6, P = .002), and they had more frequent mortality (66.7% versus 10.0%, P = .018) and worse prognosis (mRS 5–6; 100% versus 40%, P = .016) at discharge than patients without PH. CONCLUSIONS: Patients with CTO who received IA urokinase treatment based on a bridging protocol had a poor prognosis. The development of PH might affect this outcome. ASPECTSAlberta Stroke Program Early CT ScoreCTOcarotid terminus occlusionECASSEuropean Cooperative Acute Stroke StudyIAintra-arterialEMSEmergency Management of StrokeICHintracranial hemorrhageIMSInterventional Management of StrokeMELIMCA-Embolism Local Fibrinolytic Intervention TrialmRSmodified Rankin ScalePHparenchymal hematomaPROACTProlyse in Acute Cerebral ThromboembolismTICIthrombolysis in cerebral ischemia