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.
