Meraz SCA, Domínguez GLR, Camarena AG, Irigoyen MMC, Rojas JJA, Lijtszain SC

Language: Spanish
References: 19
Page: 189-195
PDF size: 184.82 Kb.

ABSTRACT

Objective: To investigate the experience of intra-arterial thrombolysis in acute stroke at Hospital ABC.
Material and methods: In a retrospective and observational study we reviewed the files of consecutive patients with stroke diagnosis in whom intra-arterial thrombolysis was performed from January 1999 to December 2002.
Results: Intra-arterial thrombolysis with recombinant tissue plasminogen activator was done in an attempt to recanalize the brain artery affected in six patients. Recanalization of the artery system was successful in these patients, and complete recovery or only minimal neurological deficits were demonstrated in them.
Conclusions: Due to the devastating natural course in patients with ischemic stroke, these initial results are encouraging and indicate that intra-arterial thrombolysis may be useful as emergency treatment in patients appropriately selected.

REFERENCES

1. Sudlow CL, Warlow CP. Comparable studies of the incidence of the stroke and its pathological types: results from an international collaboration. International Stroke Incidence Collaboration. Stroke 1997;28(3):491-9.

2. Hartmann A, Rundek T, Mast H, Paik MC, et al. Mortality and causes of death after first ischemic stroke: the Northern Manhattan Stroke Study. Neurology 2001;57(11):2000-5.

3. Caplan LR. Vertebrobasilar embolism. Clin Exp Neurol 1991;28:1-22.

4. Wijdicks EF, Scott JP. Outcome in patients with acute basilar artery occlusion requiring mechanical ventilation. Stroke 1996;27(8):1301-3.

5. Del Zoppo GJ, Higashida RT, Furlan AJ, Pessim MS, et al., and the PROACT Investigators. The prolyse in acute cerebral thromboembolism trial (PROACT): results of 6 mg dose tier. Stroke 1996;27:164-9.

6. Del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, et al. PROACT: a phase II randomized trial of recombinant prourokinase by direct arterial delivery in acute middle cerebral artery stroke. PROACT investigators. Prolyse in Acute Cerebral Thromboembolism. Stroke 1998;29(1):4-11.

7. The National Institute of Neurological Disorders and Stroke Study rt-PA Stroke Study Group. Tissue Plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333(24):1581-8.

8. Intracerebral hemorrhage after t-PA therapy for ischemic stroke. The NINDS t-PA Stroke Study Group. Stroke 1997;28(11):2109-18.

9. León M, Gloss G, Lijtszain C, Zambito BGF, et al. Trombólisis con activador tisular del plasminógeno recombinante por un evento vascular cerebral en un paciente portador de prótesis valvular aórtica tipo Bjork-Shiley. An Med Asoc Med Hosp ABC 2003;48(2):118-23.

10. Hacke W, Zeumer H, Ferbert A, Bruckmann H, et al. Intra- arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 1988;19(10):1216-22.

11. Brott T, Adams HP Jr, Olinger CP, Marler JR, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20(7):864-70.

12. Furlan A, Higashida R, Wechsler L, Gent M, et al. Intra-arterial prourokinase for acute ischemic stroke: The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999;282(21):2003-11.

13. TIMI Study Group. Special report: the thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med 1985;12:932-6.

14. Hacke W, Brott T, Caplan L, Meier D, et al. Thrombolysis in acute ischemic stroke: controlled trials and clinical experience. Neurology 1999;53(7 Suppl 4):S3-14.

15. Wijdicks EF, Nichols DA, Thielen KR, Fulgham JR, et al. Intra-arterial thrombolysis in acute basilar artery thromboembolism: the initial Mayo Clinic experience. Mayo Clin Proc 1997;72(11):1005-13.

16. Mellado TP, Sandoval RP, Tevah CJ, Huete LI, et al. Trombólisis intraarterial en trombosis de la arteria basilar. Recuperación de dos pacientes con síndrome de enclaustramiento. Rev Med Chile 2004;132(3):357-60.

17. Becker KJ, Monstein LH, Ulatowski M, Williams M, et al. Intraarterial thrombolysis in vertebrobasilar occlusion. AJNR Am J Neuroradiol 1996;17(2):255-62.

18. Cross DT 3rd, Moran CJ, Akins PT, Angtuaco EE, et al. Relationship between clot location and outcome after basilar artery thrombolysis. AJNR Am J Neuroradiol 1997;18(7):1221-8.

19. Barinagarrementería F, Cantú C, Arauz A. Trombólisis en isquemia cerebral aguda. En: Barinagarrementería F, Cantú C, editores. Terapéutica de la enfermedad vascular cerebral. México: Grupo Ixel Editores, 2002;pp:47-58.