RT Journal Article
SR Electronic
T1 Combined Direct Percutaneous Transluminal Angioplasty and Low-Dose Native Tissue Plasminogen Activator Therapy for Acute Embolic Middle Cerebral Artery Trunk Occlusion
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 277
OP 281
VO 23
IS 2
A1 Yoneyama, Takumi
A1 Nakano, Shinichi
A1 Kawano, Hirokazu
A1 Iseda, Tsutomu
A1 Ikeda, Tokuro
A1 Goya, Tomokazu
A1 Wakisaka, Shinichiro
YR 2002
UL http://www.ajnr.org/content/23/2/277.abstract
AB BACKGROUND AND PURPOSE: In embolic middle cerebral artery (MCA) trunk occlusion, recanalization with direct percutaneous transluminal angioplasty (PTA) may be preferable to time-consuming thrombolysis. However, distal embolization with small crushed fragments is a complication of direct PTA. We prospectively evaluated combined direct PTA and low-dose native tissue plasminogen activator (t-PA) therapy for acute embolic MCA trunk occlusion.METHODS: Fifteen patients underwent direct PTA. The embolus was successfully crushed in 12, who received subsequent native t-PA infusion. Direct PTA was performed with a balloon catheter, which was advanced into the occlusion site and inflated several times until recanalization was established. After PTA, 7.2 mg of native t-PA in 100 mL of isotonic sodium chloride solution was infused for 30 minutes. Neurologic status was evaluated at admission and immediately and 1 month after treatment. In all patients, follow-up CT was performed within 24 hours and 3–7 days after onset, and follow-up MR imaging, 1 month after onset.RESULTS: Direct PTA failed to crush the embolus in three of 15 patients; these three had no clinical improvement. In 11 of 12 patients, combined therapy was successful, with no technical complication. Although no symptomatic intracerebral hemorrhage occurred, one patient had a small hematoma. All patients with successful recanalization had marked clinical improvement. Although angiograms showed distal embolizations in 10, cortical infarctions were confirmed in only three at follow-up.CONCLUSION: Combined direct PTA and IV low-dose native t-PA therapy may be a safe alternative to thrombolytic therapy in some patients with embolic MCA trunk occlusion.