Thrombolysis in acute stroke without angiographically documented occlusion

Area of Science:

• Neurology
• Vascular Neurology
• Interventional Neurology

Background:

• Acute ischemic stroke management requires timely reperfusion.
• Intra-arterial thrombolysis (IAT) is a key treatment, but its efficacy in patients without angiographically-documented occlusion is debated.
• Identifying predictors of outcome is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) using urokinase (UK) in acute ischemic stroke patients who lack angiographically-confirmed arterial occlusion.
• To identify predictors of clinical outcome in this specific patient cohort.

Main Methods:

• Retrospective analysis of a thrombolysis database.
• Inclusion criteria: acute ischemic stroke, no arterial occlusion on angiography within 6 hours of symptom onset, treated with IAT using UK.
• Primary outcome: modified Rankin Scale (mRS) score ≤ 2 at 90 days.

Main Results:

• 51 patients met the inclusion criteria; median NIH stroke scale was 11.
• Mean time to treatment was 4.1 hours from symptom onset.
• 56.9% showed immediate clinical improvement; 74.5% achieved independence (mRS ≤ 2) at 90 days.
• Only one patient (2.0%) experienced symptomatic intracranial hemorrhage; no deaths occurred.

Conclusions:

• Intra-arterial thrombolysis with urokinase is a safe and effective option for acute ischemic stroke patients without angiographic occlusion.
• A significant majority (approximately 75%) of these patients experience favorable clinical outcomes.
• The low rate of symptomatic hemorrhage supports its use in selected cases.