Thrombolysis in acute stroke without angiographically documented occlusion

OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) using urokinase (UK) in acute stroke patients without angiographically-documented occlusion, and to define predictors of clinical outcome.

PATIENTS AND METHODS: We analyzed clinical and radiological data of acute ischemic stroke patients whose angiography did not show an arterial occlusion within six hours of symptom onset and who were further treated with IAT using UK. The primary outcome was a modified Rankin Scale (mRS) score ≤ 2 at 90 days’ post procedure.

RESULTS: In a thrombolysis database of 263 patients, we identified 51 patients without angiographically-documented arterial occlusion who received IAT with UK within six hours of symptom onset. The median baseline NIH stroke scale measurement was 11 (range: 8-20). From symptom onset, the mean time to treatment was 4.1 ± 1.3 h (median: 4.5 h; range: 1.5-6.0 h). Immediate and dramatically clinical improvement was seen in 29/51 (56.9%) patients. One patient (2.0%) developed a symptomatic intracranial hemorrhage. At three months, 38/51 (74.5%) patients were independent (mRS ≤2), 13/51 (25.5%) patients were dependent (mRS > 3), and no patients died. No predictors of clinical outcome were identified.

CONCLUSIONS: IAT using UK can be a safe and efficacious therapy for the treatment of acute ischemic stroke in patients without angiographic occlusion. Approximately 75% of these patients had a favorable clinical outcome and thrombolysis-related symptomatic hemorrhage was low.

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