Evaluation of intraarterial infusion of urokinase in patients with acute ischemic stroke

Objective To evaluate the results of intraarterial urokinase thrombolysis in patients with acute ischemic stroke and to define the factors affecting prognosis.Methods Forty-eight patients with angiographically proven occlusion of the intracranial arteries were treated with local intraarterial infusion of urokinase within 6 hours of symptom onset.Neurologic status was evaluated at admission and at discharge using the NIH stroke scale score(SSS).The clinical outcome was considered as improvement when the SSS decreased by at least 4.Results Complete recanalization was obtained in 17(35%) patients,including 8 of 13(62%) patients with occlusion of the vertebrobasilar artery(VBA),9 of 20 (45%) of the middle cerebral artery(MCA),and none of 15 at the internal carotid artery(ICA).Neurologic status improved in 12(60%) patients with MCA occlusion,5 (39%) of those with VBA occlusion and 3(20%) of those with ICA occlusion( P 0 05).The patients with complete recanalization of occluded MCA showed greater clinical improvement than those with partial or no recanalization( P 0 05).The overall mortality was 21%.The mortality was 43%(9/21) in patients with signs of early infarct on CT,but only 4%(1/27) in those without this sign( P 0 05).The mortality rate of patients with parenchymal hematoma(4/5) was higher than that of those patients with hemorrhagic infarct(3/9) or without hemorrhage(3/34) ( P 0 05).Conclusion Complete recanalization of occluded MCA could result in improvement of clinical outcome,patients with VBA occlusion did not benefit from recanalization. [