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Intra-arterial thrombolysis in acute ischaemic stroke
M M Jones1, J H Nogajski, K Faulder
1Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia. mmjones@med.usyd.edu.au
Internal Medicine Journal
|April 23, 2005
Summary
Intra-arterial urokinase shows promise for acute ischemic stroke treatment, offering potential advantages over intravenous methods. This retrospective study in Australia highlights its promise in select patients at expert centers.
Area of Science:
- Neurology
- Vascular Medicine
- Interventional Radiology
Background:
- Recombinant tissue plasminogen activator (IV rt-PA) is the only licensed thrombolytic for acute ischemic stroke in Australia.
- Intra-arterial (IA) thrombolysis offers potential benefits like direct thrombus visualization, higher drug concentration, and extended treatment windows, though direct comparative trials are lacking.
Purpose of the Study:
- To audit the use of IA urokinase for acute ischemic stroke.
- To evaluate outcomes and safety of IA urokinase therapy in a tertiary care setting.
Main Methods:
- Retrospective audit of IA urokinase treatment for acute ischemic stroke.
- Data collected included time to assessment and treatment, thrombus classification, symptomatic intracerebral hemorrhage, and 3-month clinical outcomes.
- Patient selection occurred at an Australian tertiary-care hospital from June 1993 to June 2003.
Main Results:
- The study examined various treatment timelines and anatomical thrombus classifications.
- Rates of symptomatic intracerebral hemorrhage were assessed.
- Clinical outcomes at 3 months post-treatment were evaluated.
Conclusions:
- IA thrombolytic therapy, specifically with urokinase, demonstrates significant promise for carefully selected acute ischemic stroke patients.
- Expert centers can effectively utilize IA thrombolysis, suggesting a valuable therapeutic option beyond current IV treatments.