Clinical Studies
Local Intraarterial Urokinase Thrombolysis of Acute Ischemic Stroke with or without Intravenous Abciximab: A Pilot Study

https://doi.org/10.1016/S1051-0443(07)61984-8Get rights and content

PURPOSE

One of the most important prognostic factors in the thrombolytic treatment of acute ischemic stroke is the time to recanalization. To shorten the recanalization time, an antiplatelet agent, abciximab (platelet glycoprotein receptor IIb/IIIa antagonist), was administered intravenously before the initiation of local intraarterial urokinase thrombolysis. The purpose of this study was to evaluate the effectiveness and safety of this combined therapy.

MATERIALS AND METHODS

A total of 26 patients with acute ischemic stroke (National Institutes of Health Stroke Scale score >10) were enrolled in this study. In the earlier phase of this study, conventional local intraarterial urokinase thrombolysis was performed in 16 patients (urokinase group). In the later phase, combined use of intravenous abciximab and local intraarterial urokinase thrombolysis was performed in 10 patients (urokinase + abciximab group). Recanalization rate (Thrombolysis in Myocardial Infarction grade >2), total amount of urokinase used, incidence of symptomatic hemorrhage, and better functional outcome rate (modified Rankin scale <2) were compared between the two groups with use of the Fisher exact test or Mann-Whitney U test.

RESULTS

The recanalization rgate in the urokinase + abciximab group (90%, nine of 10) was significantly higher than that in the urokinase group (43.8%, seven of 16) (P=.037). The mean amount of urokinase required for recanalization was significantly lower in the urokinase + abciximab group (828,000 IU vs 418,000 IU; P < .005). As for the incidence of symptomatic hemorrhage, no significant difference was noted between the two groups (four of 16 vs three of 10) (P=1.0). The urokinase + abciximab group showed a trend of better functional outcome (50% vs 80%; P=.2).

CONCLUSIONS

Combined therapy employing intravenous abciximab and local intraarterial urokinase thrombolysis showed a marked improvement in recanalization rate and showed a trend of better functional outcome. The safety of this regimen still remains to be justified with modification of the indication and regimen dosage.

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,

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    None of the authors has identified a conflict of interest.

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