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Intra-arterial thrombolysis of acute iatrogenic intracranial arterial occlusion attributable to neuroendovascular procedures or coronary angiography.
- Source :
-
Stroke [Stroke] 2008 May; Vol. 39 (5), pp. 1491-5. Date of Electronic Publication: 2008 Mar 06. - Publication Year :
- 2008
-
Abstract
- Background and Purpose: For selected stroke patients, intra-arterial thrombolysis (IAT) has been shown to be an effective treatment option. However, knowledge of safety and efficacy of IAT in patients with acute stroke as a complication of arterial catheter interventions is limited.<br />Methods: We analyzed clinical radiological findings and functional outcomes in consecutive patients 3 months after treatment with IAT for peri-procedural strokes occurring during neuroendovascular or cardiac catheter interventions. To measure outcome, the modified Rankin scale score was used.<br />Results: Of a total of 432 patients treated with IAT, 12 (4 women and 8 men; mean age, 60 years) were treated because of an ischemic stroke after a neuro-endovascular procedure (n=6) or coronary angiography (n=6). The median baseline National Institutes of Health Stroke Scale score was 15. Recanalization was complete (thrombolysis in myocardial infarction grade 3) in 6, partial (thrombolysis in myocardial infarction 2) in 5, and minimal (thrombolysis in myocardial infarction 1) in 1. Nine patients (75%) had a favorable outcome (modified Rankin scale score, 0 to 2), and 3 had a poor outcome (modified Rankin scale score, 3 or 4). All patients with complete recanalization had a favorable outcome, whereas only 3 of 6 patients with partial or minimal recanalization (P=0.18) had a favorable outcome. Follow-up brain imaging was normal in 2 and showed new ischemic lesions in 10 patients. Two patients (17%) had a symptomatic intracerebral hemorrhage.<br />Conclusions: In acute stroke attributable to arterial catheter interventions, IAT is feasible and has the potential to improve outcome in these patients. A high recanalization rate could be achieved.
- Subjects :
- Adult
Aged
Angiography, Digital Subtraction
Brain Ischemia etiology
Brain Ischemia physiopathology
Carotid Arteries physiopathology
Carotid Arteries surgery
Catheterization adverse effects
Cerebral Arteries diagnostic imaging
Cerebral Arteries drug effects
Cerebral Arteries pathology
Embolization, Therapeutic adverse effects
Female
Fibrinolytic Agents therapeutic use
Humans
Iatrogenic Disease
Intracranial Embolism etiology
Intracranial Embolism physiopathology
Magnetic Resonance Angiography
Male
Middle Aged
Prospective Studies
Stents adverse effects
Stroke etiology
Stroke physiopathology
Thrombolytic Therapy standards
Time Factors
Treatment Outcome
Urokinase-Type Plasminogen Activator therapeutic use
Brain Ischemia drug therapy
Coronary Angiography adverse effects
Intracranial Embolism drug therapy
Stroke drug therapy
Thrombolytic Therapy methods
Vascular Surgical Procedures adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4628
- Volume :
- 39
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Stroke
- Publication Type :
- Academic Journal
- Accession number :
- 18323478
- Full Text :
- https://doi.org/10.1161/STROKEAHA.107.506279