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Local thrombolytic therapy for thromboembolic occlusion of the middle cerebral artery
E Berg-Dammer1, E Möbius, H C Nahser
1Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany.
Insights
Local thrombolytic therapy effectively restored blood flow in patients with middle cerebral artery (MCA) occlusion. This treatment led to significant recovery in all patients, demonstrating its safety and efficacy for acute ischemic stroke.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Thromboembolic occlusion of the middle cerebral artery (MCA) is a common cause of severe ischemic stroke.
- Timely reperfusion is critical for improving outcomes in acute stroke patients.
- Local thrombolysis offers a targeted approach to dissolving clots in cerebral arteries.
Observation:
- The study included 10 patients with MCA occlusion, caused by either interventional procedures or cardioembolic events.
- Local thrombolytic agents (streptokinase or urokinase) were administered via microcatheter directly into the thrombus within 6 hours of symptom onset.
- All patients achieved either complete or partial revascularization of the occluded MCA.
Findings:
- Complete neurological recovery was observed in 7 out of 10 patients, with partial recovery in the remaining 3.
- Minor hemorrhagic transformation of the infarct occurred in 2 patients but did not result in neurological worsening.
- The treatment demonstrated a high success rate in restoring blood flow and facilitating patient recovery.
Implications:
- Local thrombolytic therapy is a safe and effective treatment option for selected patients with acute MCA occlusion.
- This approach may improve functional outcomes and reduce disability in patients experiencing MCA stroke.
- Further research could explore optimizing patient selection and treatment protocols for local thrombolysis in stroke.
Abstract:
We report on 10 patients with thromboembolic occlusion of the middle cerebral artery (MCA) who underwent local thrombolytic therapy. Six patients developed a MCA occlusion during long-standing interventional neuroradiological procedures, while four had a proven or suspected cardio-embolic stroke. Streptokinase or urokinase was applied by a microcatheter placed into the thrombus within six hours of clinical onset. Complete or partial revascularization was achieved in all patients. Recovery was complete in seven and partial in three of the patients. In two patients, minor haemorrhagic transformation of the infarct occurred, which did not lead to neurological deterioration. It is concluded that in a selected group of patients with MCA occlusion, local thrombolytic therapy represents a safe and effective therapy.