Intraarterial urokinase for thrombus migration after mechanical thrombectomy for large vessel ischemic stroke.
Document Type
Article
Abstract
BACKGROUND: Achieving rapid and complete reperfusion is the ultimate purpose for ischemic stroke with large vessel occlusion (LVO). Although mechanical thrombectomy (MT) had been a proverbially important procedure, medium vessel occlusion (MeVO) with thrombus migration can sporadically occur after MT. Moreover, the safe and effective approach for such had been unknown. We reported thrombolysis with intraarterial urokinase for MeVO with thrombus migration after MT.
METHODS: We included 122 patients who were treated by MT with LVO stroke at our institution between April 2019 and March 2021. Of 26 patients (21.3%) who developed MeVO with thrombus migration after MT, 11 (9.0%) underwent additional MT (MT group) and 15 (12.3%) received intraarterial urokinase (UK group). The procedure time; angiographically modified Treatment in Cerebral Ischemia Scale (mTICI); functional independence, which was defined as modified Rankin Scale 0-2, on day 30 or upon discharge; and symptomatic and asymptomatic intracerebral hemorrhage (ICH) were compared between the UK and MT groups.
RESULTS: The procedure time, mTICI, and asymptomatic ICH did not significantly differ between the groups. In the UK group, 8 of 15 (53.3%) patients obtained functional independence, and the functional independence rate was significantly higher in the UK group than in the MT group (
CONCLUSION: The results of this study suggest that intraarterial urokinase for MeVO with thrombus migration after MT may safely improve angiographic reperfusion.
Keywords
Humans, Urokinase-Type Plasminogen Activator, Stroke, Fibrinolytic Agents, Ischemic Stroke, Thrombolytic Therapy, Thrombectomy, Treatment Outcome, Brain Ischemia, Thrombosis, Cerebral Infarction, Cerebral Hemorrhage, Retrospective Studies, Mechanical Thrombolysis
Medical Subject Headings
Humans; Urokinase-Type Plasminogen Activator; Stroke; Fibrinolytic Agents; Ischemic Stroke; Thrombolytic Therapy; Thrombectomy; Treatment Outcome; Brain Ischemia; Thrombosis; Cerebral Infarction; Cerebral Hemorrhage; Retrospective Studies; Mechanical Thrombolysis
Publication Date
2-1-2023
Publication Title
Interv Neuroradiol
ISSN
2385-2011
Volume
29
Issue
1
First Page
88
Last Page
93
PubMed ID
34939475
Digital Object Identifier (DOI)
10.1177/15910199211069464
Recommended Citation
Neki, Hiroaki; Katano, Takehiro; Maeda, Takuma; Shibata, Aoto; Komine, Hiroyuki; and Kikkawa, Yuichiro, "Intraarterial urokinase for thrombus migration after mechanical thrombectomy for large vessel ischemic stroke." (2023). Translational Neuroscience. 2412.
https://scholar.barrowneuro.org/neurobiology/2412
