PT  - JOURNAL ARTICLE
AU  - Barnwell, S L
AU  - Clark, W M
AU  - Nguyen, T T
AU  - O'Neill, O R
AU  - Wynn, M L
AU  - Coull, B M
TI  - Safety and efficacy of delayed intraarterial urokinase therapy with mechanical clot disruption for thromboembolic stroke.
DP  - 1994 Nov 01
TA  - American Journal of Neuroradiology
PG  - 1817--1822
VI  - 15
IP  - 10
4099  - http://www.ajnr.org/content/15/10/1817.short
4100  - http://www.ajnr.org/content/15/10/1817.full
SO  - Am. J. Neuroradiol.1994 Nov 01; 15
AB  - PURPOSE To evaluate safety and efficacy of delayed intraarterial urokinase therapy with mechanical disruption of clot to treat thromboembolic stroke. METHODS Thirteen patients with cerebral thrombolic disease (10 carotid territory, 3 basilar territory) were treated with catheter-directed intraarterial urokinase therapy with mechanical disruption of the clots. All patients were excluded from a 6-hour multicenter thrombolytic trial by either time, recent surgery, age, seizure, or myocardial infarction. Time elapsed before treatment ranged from 3.5 to 48 hours (12 +/- 13 hours), with 200,000 to 900,000 U of urokinase used. RESULTS Ten patients had successful vessel recanalization, confirmed by repeat angiography. Cases with distal branch vessel occlusions were less likely to recanalize. Asymptomatic hemorrhagic conversion occurred in 2 patients on repeat scans. Both acute neurologic and functional outcomes were assessed with significant improvement occurring in 9 (69%) of 13 patients at 48 hours (greater than four-point change on the National Institutes of Health scale) and in 100% of 3-month survivors. All patients who improved had normal initial CT scans. CONCLUSIONS Intraarterial cerebral thrombolysis with mechanical disruption of clot seems to be a useful therapy in selected stroke cases even after 6 hours.