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Intraarterial thrombolytic therapy in acute stroke
1Department of Neurology, RWTH Aachen, FR Germany.
Acta Neurologica Belgica
|January 1, 1988
Summary
Intraarterial thrombolytic therapy using urokinase is effective for acute vertebral or basilar artery occlusion. Local therapy for carotid artery occlusion carries risks, but intravenous tPA may offer a safer alternative with strict patient selection.
Area of Science:
- Neurology
- Vascular Medicine
- Interventional Radiology
Background:
- Acute thromboembolic occlusion of the vertebral and/or basilar artery presents a significant neurological challenge.
- Local thrombolytic therapy has been explored for acute thromboembolic occlusions within the carotid artery territory.
Purpose of the Study:
- To evaluate the efficacy and safety of intraarterial thrombolytic therapy for acute thromboembolic occlusions.
- To assess the risks and potential benefits of local thrombolytic therapy in different cerebrovascular territories.
Main Methods:
- Intraarterial thrombolysis using urokinase was administered in cases of vertebral and/or basilar artery occlusion.
- Local thrombolytic therapy was considered for selected cases of acute thromboembolic occlusion in the carotid artery territory.
Main Results:
- Intraarterial urokinase therapy demonstrated effectiveness and safety in acute vertebral/basilar artery occlusions, with minor hemorrhages not worsening neurological status.
- Local thrombolytic therapy in the carotid artery territory showed potential efficacy in highly selected cases but carried a high risk of intracerebral hemorrhage.
Conclusions:
- Intraarterial thrombolysis with urokinase is a viable option for specific acute vertebrobasilar occlusions.
- Intravenous tissue plasminogen activator (tPA) may supersede local intraarterial thrombolysis for carotid occlusions, contingent upon strict patient selection, dosage, and timing protocols.