Local intra-arterial fibrinolysis in acute XXXX : effect of occlusion type and fibrinolytic agent on recanalization success and neurological outcome.

@entity1 @entity64 @entity548 @entity2500 @entity204
BACKGROUND: To evaluate the effect of occlusion type and fibrinolytic agent on recanalization success and clinical outcome in @entity1 undergoing local intra-arterial fibrinolysis (LIF) in acute @entity64 . METHODS: LIF was performed in 137 @entity1 with angiographically established occlusion in the carotid circulation within 6 h of @entity64 onset. Retrospective analysis included recanalization success, recanalization time, type of occlusion and fibrinolytic treatment mode. Five types of occlusion were categorized: intracranial bifurcation (carotid 'T') of the internal carotid artery (ICA; n = 35); proximal segment of the middle cerebral artery (MCA; n = 66); distal segment of the MCA (n = 20); @entity2500 (n = 8); multiple peripheral branches of the anterior cerebral artery and the MCA (n = 8). Neurologic outcome was evaluated after 3 months by Barthel Index (BI) as good (BI >90), moderate (BI 50-90), poor (BI <50) or @entity204 . RESULTS: Recanalization was achieved in 74 @entity1 (54%). Mean recanalization time in recanalized @entity1 was 91 min. Neurologic outcome was good in 48 @entity1 (35%), moderate in 34 (25%), poor in 30 (22%) and 25 died (18%). Outcome was significantly better in recanalized than in nonrecanalized @entity1 (p < 0.001). Treatment results were significantly better in proximal and distal MCA occlusion than in carotid 'T' occlusions (p < 0.001). Recanalization success hardly differed between urokinase and rt-PA. Combined treatment with rt-PA and lys-plasminogen tended toward a faster recanalization. @entity548 occurred in 13 @entity1 (9%). CONCLUSION: The type of occlusion is of high prognostic value for successful fibrinolysis in the anterior circulation. However, recanalization is a time-consuming process even with an intra-arterial approach. Recanalization did not differ between type or dosage of plasminogen activators. Further innovative attempts are warranted towards hastening recanalization time in endovascular acute @entity64 treatment.
