PT  - JOURNAL ARTICLE
AU  - S.H. Baik
AU  - C. Jung
AU  - J.Y. Kim
AU  - D.-W. Shin
AU  - B.J. Kim
AU  - J. Kang
AU  - H.-J. Bae
AU  - J.H. Kim
TI  - Local Intra-arterial Thrombolysis during Mechanical Thrombectomy for Refractory Large-Vessel Occlusion: Adjunctive Chemical Enhancer of Thrombectomy
AID  - 10.3174/ajnr.A7264
DP  - 2021 Nov 01
TA  - American Journal of Neuroradiology
PG  - 1986--1992
VI  - 42
IP  - 11
4099  - http://www.ajnr.org/content/42/11/1986.short
4100  - http://www.ajnr.org/content/42/11/1986.full
SO  - Am. J. Neuroradiol.2021 Nov 01; 42
AB  - BACKGROUND AND PURPOSE: Data on adjunctive intra-arterial thrombolysis during mechanical thrombectomy for refractory thrombus are sparse. The aim of this study was to evaluate the efficacy and safety of local intra-arterial urokinase as an adjunct to mechanical thrombectomy for refractory large-vessel occlusion.MATERIALS AND METHODS: We retrospectively evaluated patients with acute ischemic stroke who underwent mechanical thrombectomy for anterior circulation large-vessel occlusion between January 2016 and December 2019. Patients were divided into 2 groups based on the use of intra-arterial urokinase as an adjunctive therapy during mechanical thrombectomy for refractory thrombus: the urokinase and nonurokinase groups. Herein, refractory thrombus was defined as the target occlusion with minimal reperfusion (TICI 0 or 1) despite >3 attempts with conventional mechanical thrombectomy. The baseline characteristics, procedural outcomes, and clinical outcome were compared between the 2 groups.RESULTS: One hundred fourteen cases of refractory thrombus were identified. A total of 45 and 69 patients were in the urokinase and the nonurokinase groups, respectively. The urokinase group compared with the nonurokinase group showed a higher rate of successful reperfusion (82.2% versus 63.8%, P = .034), with lower procedural times (54 versus 69 minutes, P = .137). The rates of good clinical outcome, distal embolism, and symptomatic intracranial hemorrhage were similar between the 2 groups. The use of intra-arterial urokinase (OR = 3.682; 95% CI, 1.156–11.730; P = .027) was an independent predictor of successful reperfusion.CONCLUSIONS: The use of local intra-arterial urokinase as an adjunct to mechanical thrombectomy may be an effective and safe method that provides better recanalization than the conventional mechanical thrombectomy for refractory thrombus in patients with embolic large-vessel occlusion.CAcontact aspirationIAintra-arterialICHintracerebral hemorrhageIQRinterquartile rangeLVOlarge-vessel occlusionMTmechanical thrombectomymTICImodified TICISRstent retrieversICHsymptomatic ICHUKurokinase