Direct Intra-Arterial Fibrinolysis in Acute Stroke Therapy Management

pp 291-296

Abstract

Treatment of patients with an acute thromboembolic stroke are now being managed in selected cases by catheterization and infusion of thrombolytic agents directly into the blood clot within the intracranial cerebral vasculature. From a transfemoral arterial approach under local anesthesia, a 2.5 French microcatheter can be guided into the intra-cranial circulation and embedded within the clot. Infusion of fibrinolytic agents are then performed into the thrombus until lysis is achieved and perfusion restored. Direct fibrinolytic therapy has now been performed in 27 patients involving 45 vascular territories. Clinically there was neurological improvement in 18 (66.7%) cases. Complications related to therapy included symptomatic intracranial hemorrhage in 3 cases (11.1%) which included one case (3.7%) of vessel perforation. Neurologically there were 8 (29.6%) patients with no evidence of clinical improvement following treatment, and in long term followup there were9 (33,3%) patient deaths. In summary, local direct intra-arterial infusion of thrombolytic drugs may improve overall patient morbidity and mortality related to acute thromboembolic disease in the central nervous system compared to the natural history of this disorder. Further clinical studies are therefore warranted to evaluate this form of therapy.