Article Text

Download PDFPDF
Intra-arterial thrombolysis in 24 consecutive patients with internal carotid artery T occlusions
  1. M Arnold1,
  2. K Nedeltchev1,
  3. H P Mattle1,
  4. T J Loher1,
  5. F Stepper1,
  6. G Schroth2,
  7. C Brekenfeld2,
  8. M Sturzenegger1,
  9. L Remonda2
  1. 1Department of Neurology, University Hospital of Berne, Switzerland
  2. 2Department of Neuroradiology, University Hospital of Berne
  1. Correspondence to:
 Dr L Remonda, Department of Neuroradiology, University of Berne, Freiburgstrasse, Inselspital, CH-3010 Berne, Switzerland; 
 luca.remonda{at}insel.ch

Abstract

Objectives: To determine the safety, efficacy, and predictors of favourable outcome of intra-arterial thrombolysis in acute stroke attributable to internal carotid “T”occlusion

Methods: The authors analysed 24 consecutive patients with T occlusions of the internal carotid artery treated by local intra-arterial thrombolysis using urokinase.

Results: The median baseline National Institutes of Health Stroke Scale was 19. The average time from symptom onset to treatment was 237 minutes. Four patients (16.6%) had a favourable (modified Rankin Scale score (mRS⩽2)) and 10 patients (41.7%) a poor outcome (mRS 3 or 4) after three months. Ten patients (41.7%) died. One symptomatic intracerebral haemorrhage (4.2%) occurred. Partial recanalisation of the intracranial internal carotid artery was achieved in 15 (63%), of the middle cerebral artery in four (17%), and of the anterior cerebral artery in eight patients (33%). Complete recanalisation never occurred. Sufficient leptomeningeal collaterals as seen on arteriography (p=0.02) and age <60 years (p=0.012) were the only predictors of favourable clinical outcome.

Conclusions: Acute stroke attributable to carotid T occlusion remains a condition with a generally poor prognosis even when intra-arterial thrombolysis is performed. Favourable outcome was seen only in patients with sufficient leptomeningeal collaterals.

  • stroke
  • thrombolytic therapy
  • ICA, intra-arterial thrombolysis
  • CTO, carotid artery T occlusions
  • NIHSS, National Institutes of Health Stroke Scale
  • ICA, internal carotid artery
  • MCA, middle cerebral artery
  • CT, computed tomography
  • mRS, modified Rankin scale
  • ACA, anterior cerebral artery

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • Competing interests: none declared.