Summary
A group of 59 patients with stroke due to acute vertebrobasilar or carotid territory occlusion have been treated by local intra-arterial fibrinolysis (LIF). A high recanalisation rate was accomplished with either urokinase or recombinant tissue plasminogen activator (r-TPA). However, with either substance, even if a high dose was used, recanalisation was a time-consuming process which usually took 120 min. A reasonable explanation for the lack of effectiveness of these plasminogen-activating substances might be a deficit of substrate, e.g. plasminogen, in aged thrombus. LIF was capable of improving clinical outcome in acute vertebrobasilar artery occlusion, reducing mortality to 50% in patients fulfilling inclusion criteria. In the carotid territory multiple occlusions had a poor prognosis while good clinical results could be achieved in occlusions of the proximal middle cerebral artery or single branches.
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References
Siepmann G, Müller-Jensen M, Goossens H, Lachenmayer L, Zeumer H (1991) Local intraarterial fibrinolysis in acute middle cerebral arteryocclusion. Neuroradiology 33 [Suppl]: 69–71
Zeumer H, Freitag HJ, Grzyska U, Neunzig HP (1989) Local intraarterial fibrinolysis in acute vertebrobasilar occlusion. Technical developments and recent results. Neuroradiology 31: 336–340
Zeumer H, Freitag HJ, Knospe V (1992) Fibrinolysis in cerebrovascular diseases of the central nervous system. In: Viñuela F, et al. (eds) Interventional neuroradiology. Neuroimaging Clinics of North America. Saunders, Philadelphia, pp 359–369
Seifried E (1988) Klinische und biochemische Zielsetzungen bei der Thrombolysetherapie mit Neothrombolytika speziell mit Gewebeplasminogenaktivator, Prourokinase und deren Kombinationen. Hämostaseologie 8: 199–213
Jang IK, Gold HK, Ziskind AA, Leinbach RC, Fallon JT, May JW, Collen D (1988) Resistance to rt-PA is produced by an increased platelet concentration in occluding thrombi. Circulation 78 (Suppl II): 211
Brockmann MJ, Schwendemann G, Stief TW, Heimburger N (1989) Plasminogen Aktivator Inhibitor bei akuten zerebralen Infarkten. Verh Deutsch Ges Neurol 5: 1086–1089
Gottlob R (1970) Die Grundlage für die Lyse alter Thromben. In: Pezold FA (ed) Fibrinolyse-Therapie heute. Schattauer, Stuttgart, pp 75–86
Hess H (1989) Lokale Lyse bei peripheren arteriellen Verschlüssen. Herz 14: 12–21
Möbius E, Berg-Dammer E, Kühne D, Kunitsch G, Nahser HC (1989) Lokale intraarterielle Fibrinolyse: Therapie der Wahl bei A. Basilarisverschluß mit progredientem Hirnstamminfarkt. Aktuel Neurol 16: 184–190
TIMI Study Group (1989) Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the thrombolysis in (TIMI) phase II trial. N Engl J Med 320: 618–627
Kummer R von, Hacke W (1992) Safety and efficacy of intravenous tissue plasminogen activator and heparin in acute middle cerebral artery stroke. Stroke (in press)
Archer CR, Horenstein S (1977) Basilar artery occlusion. Clinical and radiological correlation. Stroke 8: 383–390
Hacke W, Zeumer H, Ferbert A, Brückmann H, DelZoppo GJ (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. stroke 19: 1216–1222
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Zeumer, H., Freitag, H.J., Zanella, F. et al. Local intra-arterial fibrinolytic therapy in patients with stroke: urokinase versus recombinant tissue plasminogen activator (r-TPA). Neuroradiology 35, 159–162 (1993). https://doi.org/10.1007/BF00593977
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DOI: https://doi.org/10.1007/BF00593977