Early Local Intra-Arterial Thrombolysis for Severe Middle Cerebral Artery Stroke

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Abstract
Nineteen patients selected for acute hemispheric stroke, severe and stable motor impairment and angiographically proven occlusion of middle cerebral artery trunk or internal carotid artery siphon within 6 h from symptoms onset were treated with graded local urokinase injections using a superselective approach. Eleven of them (58%) displayed partial or subcomplete reperfusion after 900,000 units of urokinase. On follow-up computed tomography, mass effect was severe in 12 patients and moderate in 3 patients. Only 1 patient developed a brain hematoma with clinical deterioration. Good or fair outcome correlated with the presence of collateral blood flow (p < 0.003) and reperfusion (p < 0.007). All patients with collaterals demonstrated immediate recanalization. Local superselective arterial thrombolysis led to a relatively high reperfusion rate, although needing unexpectedly large doses of urokinase. The study emphasizes the central importance of leptomeningeal blood flow for both the likelihood of immediate reperfusion and prognosis.

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