Review of the Current Status of Intra-Arterial Thrombolysis for Treating Acute Cerebral Infarction: a Retrospective Analysis of the Data from Multiple Centers in Korea.
- Author:
Deok Hee LEE
1
;
Dong Gyu NA
;
Yon Kwon IHN
;
Dong Joon KIM
;
Eung Yeop KIM
;
Yong Sun KIM
;
Soo Mee LIM
;
Hong Gee ROH
;
Chul Ho SOHN
Author Information
- Publication Type:Original Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
- Keywords: Brain ischemia; Brain infarction; Thrombolytic therapy
- MeSH: Acute Disease; Cerebral Angiography; Cerebral Infarction/diagnosis/*drug therapy; Female; Fibrinolytic Agents/*administration & dosage; Humans; Injections, Intra-Arterial; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Thrombolytic Therapy/*methods/standards; Tomography, X-Ray Computed; Treatment Outcome
- From:Korean Journal of Radiology 2007;8(2):87-93
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: The purpose of the study was to review the current status of intra-arterial (IA) thrombolysis in Korea by conducting a retrospective analysis of the data from multiple domestic centers. MATERIALS AND METHODS: The radiologists at each participating institution were asked to fill out case report forms on all patients who had undergone IA recanalization due to acute anterior circulation ischemia. These forms included clinical, imaging and procedure-related information. A central reader analyzed the CT/MR and angiographic results. The rates of successful recanalization, hemorrhagic transformation and functional outcome were obtained. The univariate analyses were performed together with the multivariate analysis. RESULTS: We analyzed the data from 163 patients, and they had been treated at seven institutes. The initial imaging modalities were CT for 46 patients (28%), MR for 63 (39%), and both for 54 (33%). Various mechanical treatment methods were applied together in 50% of the patients. Radiologically significant hemorrhage was noted in 20/155 patients (13%). We found various factors that influenced the recanalization rate and the occurrence of significant hemorrhagic transformations. The favorable outcome rate, reported as modified Rankin Scale < or = 2, was 40%, and the mortality rate was 11%. The factors that predicted a poor functional outcome were old age (p = 0.01), initially severe neurological symptoms (p < 0.0001), MR findings of a wide distribution of lesions (p = 0.001), involvement of the basal ganglia (p = 0.01), performance of procedures after working hours (p = 0.01), failure of recanalization (p = 0.003), contrast extravasation after the procedure (p = 0.007) and significant hemorrhagic transformation (p = 0.002). The subsequent multivariate analysis failed to show any statistically significant variable. CONCLUSION: There was a trend toward increased dependency on MR imaging during the initial evaluation and increased usage of combined pharmacologic/mechanical thrombolysis. The imaging and clinical outcome results of this study were comparable to those of the previous major thrombolytic trials.
