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22. European Stroke Conference 615 Acute stroke: emergency management, stroke units and complications Intra-arterial thrombolysis with urokinase in 490 cases of acute ischemic stroke: a single cen-ter 672 © 2013 S. Karger AG, Basel Scientific Programme analysis Y. Wang1, F. Ling2, Liqun Jiao3, X. Ji4, S. Li5, Fengshui Zhu6, Z. Miao7 Department of Neurosurgy, Xuanwu Hospital, Capital medical University, Beijing, CHINA1, Department of Neurosurgy, Xuanwu Hospital, Capital medical University, Beijing, CHINA2, De-partment of Neurosurgy, Xuanwu Hospital, Capital medical University, Beijing, CHINA3, Depart-ment of Neurosurgy, Xuanwu Hospital, Capital medical University, Beijing, CHINA4, Department of Neurosurgy, Xuanwu Hospital, Capital medical University, Beijing, CHINA5, Department of Neurosurgy, Xuanwu Hospital, Capital medical University, Beijing, CHINA6, Department of Neuro-surgy, Xuanwu Hospital, Capital medical University, Beijing, CHINA7 Objective:To evaluate the safety and efficacy of intra-arterial thrombolysis with urokinase in the treatment of acute ischemic stroke due to artery occlusion of anterior/posterior circulation. Methods:We performed a retrospective review (Jan 2000–Sep 2010) that included 490 consecutive patients who had endovascular therapy after acute ischemic stroke due to artery occlusion of anteri-or/ posterior circulation. We analyzed the recanalization rate(TIMI), symptomatic intracranial hem-orrhage (SICH) rate and modified Rankin Scale score.Results:The study included 350 male and 140 female patients with a mean age of 55.9 years.389 patients had anterior circulation ischemic events. The median NIHSS score at the time of admission was 16 for the patients with anterior circulation and 23 for those with posterior circulation. The mean time from stroke onset to angiogram was 5.2h and 9.6h(anterior circulation patients/posterior circulation patients).The mean urokinase dose ad-ministered to the anterior circulation patients was 9.42×100000 IU and 10.1×100000 IU for patients with posterior circulation.Besides intra-arterial thrombolysis with urokinase, endovascular therapy included simple mechanical thrombolysis with microwire (anterior/posterior circulation, 279/89), intracranial or extracranial angioplasty with stent (anterior/posterior circulation, 56/19) and balloon angioplasty (anterior/posterior circulation, 12/11). We found that partial-to-complete recanalization (TIMI 2 or 3) was achieved in 61.7% of anterior circulation patients and 64.3% of posterior circula-tion patients. 34.2% of anterior circulation patients and 21.8% of posterior circulation patients had good outcomes at discharge (mRS 2 or less) and the rate of post procedure SICH is 13.3% for the anterior circulation patients and 5% in the posterior circulation patients. Conclusion:Intra-arterial thrombolysis using urokinase in patients with acute ischemic stroke could achieve re-vasculariza-tion, but a higher rate of SICH remained the major risk factor affecting its safety and was related to the poor prognosis in our study. Table 1: Characteristics of the patients in our study All Anterior cir-culation stroke (n=389) Posterior cir-culation stroke (n=101) Age (years, mean±SD) 55.9±13.9 56.1±14.3 54.8±12.5 Male (n), % 350, 71.4% 298, 76.6% 52, 51.5% NIHSS score on admis-sion( median) 17 16 23 Endovascular therapy via different methods (n) Thrombectomy with microwire 368 279 89 Angioplasty with stent 75 56 19 Angioplasty with balloon 23 12 11 Time to treatment (h, mean±SD) 6.1±2.5 5.2±1.2 9.6±2.8 Dosage of urokinase (105 IU, mean±SD) 9.65±2.78 9.42±2.58 10.1±2.44 Table 2. Comparisons of salient features among the NINDS, MELT, MERCI, IMS II, Multi MERCI studies, BASICS and our study Study comparison NIHSS on admission (median) Recanaliza-tion (TIMI2-3) Outcome (mRS 0-2) Rate of SICH NINDS (IV t-PA, n=312) 14 39% 6.4% MELT (IAT, n=57) 14 73.7% 49.1% 9% Anterior circulation (our study, n=389) 16 61.7% 34.2% 13.3% Cervical ICA (n=83) 51,61.4% 29,34.9% 12,14.5% ICA T occlution (n=67) 25,37.3% 15,22.3% 11,16.4% MCA(n=223) 151,67.7% 75,33.6% 28,12.6% ACA(n=16) 13,81.3% 14,87.5% 1,6.3% Posterior circulation (our study, n=101) 23 64.3% 21.8% 5% VA (n=48) 37,77.1% 12,25% 1,2% BA (n=53) 28,52.8% 10,18.8% 4,7.5% IMS II (IAT, n=55) 19 60% 46% 9.9% Multi-MERCI (n=164) 19 69.5% 36% 9.8% BASICS (IAT group) 25 72% 25.7% 14% NINDS: National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study; MELT: The Middle Cerebral Artery Embolism Local Fibrinolytic Intervention Trial (MELT) Japan; IMS II: Interventional Management of Stroke Study II; Multi-MERCI: Multi MERCI trial; BASICS: Treatment and outcomes of acute basilar artery occlusion in the Basi-lar Artery International Cooperation Study;


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