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Comparison of the Incidence of parenchymal hematoma and poor outcome in patients with carotid terminus occlusion treated with intra-arterial urokinase alone or with combined IV rtPA and intra-arterial urokinase

Lee, JS; Hong, JM; Kim, EJ; Shin, DH; Joo, IS; Lim, YC; Suh, SH; Kim, SY
AJNR. American journal of neuroradiology, 33(1):175-179, 2012
Journal Title
AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol.

MATERIALS AND METHODS: Sixteen consecutive patients with acute ischemic stroke due to CTO who had combined IV and IA or a single IA thrombolytic treatment were enrolled. The baseline characteristics and prognosis were described. The patients who did and did not develop a PH shortly after treatment were compared.

RESULTS: The mean age was 66.4 years, and the median initial NIHSS score was 17. The median dose of IA urokinase was 320,000 U, and recanalization (TICI grade II-III) was achieved in 12 patients (75%). However, 5 patients died and 10 patients had poor prognosis with mRS 5-6 at discharge. Six patients (37.5%) with a PH had a higher NIHSS score 1 day after treatment (26.7 versus 13.6, P = .002), and they had more frequent mortality (66.7% versus 10.0%, P = .018) and worse prognosis (mRS 5-6; 100% versus 40%, P = .016) at discharge than patients without PH.

CONCLUSIONS: Patients with CTO who received IA urokinase treatment based on a bridging protocol had a poor prognosis. The development of PH might affect this outcome.
MeSH terms
AgedAged, 80 and overCerebral Hemorrhage/*drug therapy/*radiographyDrug Therapy, CombinationFemaleFibrinolytic Agents/*administration & dosageHumansInjections, Intra-ArterialInjections, IntravenousMaleMiddle AgedRecombinant Proteins/administration & dosageTissue Plasminogen Activator/*administration & dosageTreatment Outcome
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Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
Journal Papers > School of Medicine / Graduate School of Medicine > Neurology
Journal Papers > School of Medicine / Graduate School of Medicine > Neurosurgery
AJOU Authors
이, 진수홍, 지만신, 동훈주, 인수임, 용철김, 선용
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