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| Research in Radiology/RSNA 2000 |
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I'm Dr. Cerase from Sienna, Italy, and I'm here at RSNA to present the experience of my department in the treatment of stroke patients by selective intra-arterial thrombolysis. I work in Sienna and the work was performed mainly by my chief, Dr. Carlo Venturi, and his co-workers, Dr. Paulo Gennari and Dr. Sandra Bracco.
The problem of stroke and the related morbidity and mortality and the need
for treatment in the early hours after the onset of symptoms. So selective
intra-arterial thrombolysis is a good tool and this was confirmed by our
experience. We treated the 49 patients, 42 patients with anterior circulation
stroke and seven patients with posterior circulation stroke. The inclusion
exclusion criteria of the treatment are those well known and, above all
the inclusion criteria for ours had to be that the procedure of thrombolysis
had to be ended by the end of the sixth hour after symptoms onset.
By these criteria we had recanalization in 55 percent of patients angiographic
recanalization and had a good outcome in 51 percent of patients. The incidence
of hemorrhagic events were similar to the other thrombolysis studies and
we had three parenchymal hematomas and two of them, unfortunately, led to
the death of the patients and eight hemorrhagic transformation of the lesion
without a neurologic deterioration.
Worst outcome was in the occlusion of the bifurcation of internal carotid
artery as well as in the occlusion of proximal internal carotid artery with
distal embolism. On the other hand, we had the good results in the involvement
of middle cerebellar artery occlusions. Regarding the involvement of basilar
artery thrombosis, we think that the procedure should be performed considering
the bad outcome of medical treatment of basilar artery thrombosis. In conclusion,
in our experience the intra-arterial administration of eurokinase was
an effective tool for the treatment of acute ischemic stroke patients. Furthermore,
with this procedure, and superselective catheterization you may achieve
a mechanical disruption of the thrombus. The procedure in our experience
was safe with a low rate of adverse events. And these are our conclusions
although our population was we can say these, although our population was
small and the follow-up short. Obviously, further studies are needed to
evaluate the effectiveness of such therapy. Thank you.
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