INTRA-ARTERIAL THROMBOLYTIC THERAPY IN ACUTE MIDDLE CEREBRAL ARTERY STROKE

18 patients presenting with acute carotid territory stroke, secondary to angiographically demonstrated occlusion of the middle cerebral artery (MCA), have been treated within 8 hours of the onset of acute symptoms by local intra-arterial infusion of urokinase or streptokinase. All patients were screened by baseline CT cerebral scan to exclude intracerebral hemorrhage as a cause of the acute stroke. 14 patients demonstrated complete, 2 partial, and 2 no recanalization (reopening) of the previously occluded artery following a 1 to 2 hour infusion of the fibrinolytic agent.

10 of the 14 patients displaying complete recanalization had complete neurological recovery or improvement with residual neurological deficits, while the 2 patients who did not display recanalization did not improve clinically. No clinical improvement was observed in the absence of recanalization.

Hemorrhagic transformation of cerebral ischemic areas may be classified as hemorrhagic infarction (minimal hemorrhage, no clinical deterioraton) and parenchymatous hemorrhage (mass effect, clinical deterioration). Minor infarction-related hemorrhages without detectable neurological sequelae (hemorrhagic infarctions) were found by CT scan in 4 patients; all displayed complete recanalization; and all hemorrhagic infarctions resolved.

This uncontrolled prospective clinical experience suggests that early local infusion of thrombolytic agents in selected patients may be efficacious and safe.