Clinical StudiesLocal Intraarterial Urokinase Thrombolysis of Acute Ischemic Stroke with or without Intravenous Abciximab: A Pilot Study
Section snippets
Study Group
This study was largely composed of two phases. In the earlier phase (from September 1999 to February 2001), conventional local intraarterial urokinase thrombolysis was performed in 16 patients (urokinase group). In the following phase (from March 2001 to August 2001), intravenous infusion of abciximab was performed before local intraarterial urokinase thrombolysis in 10 patients (urokinase + abciximab group). The patient demographics of the two groups are summarized in the Table. The
RESULTS
With successful recanalization defined as vessel patency better than TIMI grade II, the recanalization rates of the urokinase group and the urokinase + abciximab group were 43.8% (seven of 16) and 90% (nine of 10), respectively. The difference was significant (P μ .037). The final TIMI grades of two groups are compared in the Figure. It was remarkable that there was no case of complete recanalization in the urokinase group, whereas six patients with TIMI grade III patency in the urokinase +
DISCUSSION
Local intraarterial urokinase thrombolysis after intravenous administration of abciximab revealed significant improvement in recanalization rate. This method also showed a better clinical outcome although we failed to demonstrate its statistical significance. There was no evidence of increased frequency of bleeding complications with this combined (urokinase + abciximab) method.
There are several advantages of this combined method compared to conventional local intraarterial thrombolysis. First,
References (30)
- et al.
Acute stroke intervention with intraarterial urokinase infusion
J Vasc Interv Radiol
(1994) - et al.
Acceleration of thrombolysis with ultrasound through the cranium in a flow model
Ultrasound Med Biol
(2000) - et al.
Local intraarterial thrombolysis in vertebrobasilar thromboembolic disease
Am J Neuroradiol
(1983) - et al.
Intracarotid urokinase with thromboembolic occlusion of the middle cerebral artery
Stroke
(1988) - et al.
Local intra-arterial fibrinolytic therapy in acute carotid territory stroke: a pilot study
Stroke
(1988) - et al.
Local intra-arterial thrombolysis in acute ischemic stroke
Stroke
(1998) - et al.
Outcome after local intra-arterial fibrinolysis compared with the natural course of patients with a dense middle cerebral artery on early CT
Neuroradiology
(1998) - et al.
Intraarterial recombinant tissue plasminogen activator for ischemic stroke: an accelerating dosing regimen
Neurosurgery
(2000) - et al.
Local intracranial intraarterial thrombolytic therapy in acute cerebral infarction
J Korean Radiol Soc
(1996) - et al.
Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial
JAMA
(1999)
Combined intraarterial/intravenous thrombolysis for acute ischemic stroke
Am J Neuroradiol
Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke: emergency management of stroke (EMS) bridging trial
Stroke
Fibrinolytic therapy for acute embolic stroke: intravenous, intracarotid, and intra-arterial local approaches
Neurosurgery
Lys-plasminogen as an adjunct to local intra-arterial fibrinolysis for carotid territory stroke: laboratory and clinical findings
Neuroradiology
Other endovascular treatment strategies for acute ischemic stroke
Neuroimaging Clin N Am
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None of the authors has identified a conflict of interest.