Comparative efficacy of intra-arterial thrombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke

Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator （rtPA） for acute ischemic stroke. Methods A total of 43 patients with acute ischemic stroke within 6 hours of onset were included, 31 of them underwent superselective intra-arterial thrombolysis in the intra-arterial thrombolysis group and 12 of them underwent intravenous thrombolysis with rtPA in the intravenous thrombolysis group. Vascular recanalization was observed in the intra-arterial thrombolysis group, and the modified Rankin scale （mRS） scores at day 90 were used to evaluate the outcomes in both groups. Results Eighteen patients （58.1%） had complete recanalization and 7 （22.6%） had partial recanalization in the intra-arterial thrombolysis group. The recanalization rate was 80.6%, 3 complicated symptomatic intracranial hemorrhage, and 1 died. There vere no significant differences between the good outcome rate （74.2% vs. 66.7%, x2 =0.24, P=0.622） and the incidence of symptomatic intracranial hemorrhage at 90 d （9. 68% vs. 8. 33%, x2 =0. 19, P =0. 892）. Conclusions Urokinase intra arterial thrombolysis within the time window can significantly improve the recanalization rate of the occluded vessels and improve the clinical symptoms of the patents in acute phase and long term outcomes. Their short-term efficacy and long-term outcomes are almost the same with intrave nous thrombolysis with rtPA. Key words: Stroke;  Brain ischemia;  Thrombolytic therapy;  Urokinase;  Tissue plasminogen activator;  Treatment outcome