Percutaneous balloon angioplasty for acute occlusion of intracranial arteries
BACKGROUND: The benefits of intravenous thrombolysis for acute ischemic stroke are still limited. OBJECTIVE: To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries. METHOD...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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2010
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| _version_ | 1826264333836877824 |
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| author | Tokunaga, K Sugiu, K Yoshino, K Terai, Y Imaoka, T Handa, A Hirotsune, N Kusaka, N Date, I |
| author_facet | Tokunaga, K Sugiu, K Yoshino, K Terai, Y Imaoka, T Handa, A Hirotsune, N Kusaka, N Date, I |
| author_sort | Tokunaga, K |
| collection | OXFORD |
| description | BACKGROUND: The benefits of intravenous thrombolysis for acute ischemic stroke are still limited. OBJECTIVE: To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries. METHODS: Fifty-nine patients with acute occlusion of intracranial arteries were enrolled. A Gateway balloon catheter was used to disrupt clots or dilate atheromatous plaques in every patient. The technical details, technique-related complications, recanalization rates, and clinical outcomes were analyzed. RESULTS: The occlusion sites were internal carotid arteries in 17 patients, M1 segments in 32 patients, the M2 segment in 1 patient, a vertebral artery in 1 patient, and basilar arteries in 8 patients. Twenty-four patients (41%) were treated with thrombolysis first, and 20 patients (34%) were treated with percutaneous transluminal angioplasty (PTA) followed by thrombolysis. PTA alone was performed in 15 patients (25%). The mean dose of urokinase was 205 × 10 U. The extent of recanalization was complete (Thrombolysis in Myocardial Infarction [TIMI] score of 3) in 17 patients (29%), and partial (TIMI 1/2) in 28 patients (47%). Functional independence at discharge was preserved in 76%, 25%, and 7% of patients with TIMI 3, TIMI 1/2, and TIMI 0, respectively. A combination of PTA and thrombolysis resulted in a significantly higher recanalization rate than PTA only. Seven patients (12%) experienced hemorrhagic events after treatment. Severe parenchymal hemorrhage with neurologic deterioration was observed in 2 patients (4%), and vessel rupture was encountered in 1 atherosclerotic case. CONCLUSIONS: Mechanical angioplasty using a Gateway catheter combined with a low-dose thrombolytic agent is a safe and effective treatment for acute intracranial embolic and atherosclerotic occlusion with a low risk of hemorrhagic complications. Copyright © 2010 by the Congress of Neurological Surgeons. |
| first_indexed | 2024-03-06T20:06:07Z |
| format | Journal article |
| id | oxford-uuid:28f5ce6b-c9d8-4f91-90f0-427340bee3ae |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T20:06:07Z |
| publishDate | 2010 |
| record_format | dspace |
| spelling | oxford-uuid:28f5ce6b-c9d8-4f91-90f0-427340bee3ae2022-03-26T12:16:12ZPercutaneous balloon angioplasty for acute occlusion of intracranial arteriesJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:28f5ce6b-c9d8-4f91-90f0-427340bee3aeEnglishSymplectic Elements at Oxford2010Tokunaga, KSugiu, KYoshino, KTerai, YImaoka, THanda, AHirotsune, NKusaka, NDate, IBACKGROUND: The benefits of intravenous thrombolysis for acute ischemic stroke are still limited. OBJECTIVE: To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries. METHODS: Fifty-nine patients with acute occlusion of intracranial arteries were enrolled. A Gateway balloon catheter was used to disrupt clots or dilate atheromatous plaques in every patient. The technical details, technique-related complications, recanalization rates, and clinical outcomes were analyzed. RESULTS: The occlusion sites were internal carotid arteries in 17 patients, M1 segments in 32 patients, the M2 segment in 1 patient, a vertebral artery in 1 patient, and basilar arteries in 8 patients. Twenty-four patients (41%) were treated with thrombolysis first, and 20 patients (34%) were treated with percutaneous transluminal angioplasty (PTA) followed by thrombolysis. PTA alone was performed in 15 patients (25%). The mean dose of urokinase was 205 × 10 U. The extent of recanalization was complete (Thrombolysis in Myocardial Infarction [TIMI] score of 3) in 17 patients (29%), and partial (TIMI 1/2) in 28 patients (47%). Functional independence at discharge was preserved in 76%, 25%, and 7% of patients with TIMI 3, TIMI 1/2, and TIMI 0, respectively. A combination of PTA and thrombolysis resulted in a significantly higher recanalization rate than PTA only. Seven patients (12%) experienced hemorrhagic events after treatment. Severe parenchymal hemorrhage with neurologic deterioration was observed in 2 patients (4%), and vessel rupture was encountered in 1 atherosclerotic case. CONCLUSIONS: Mechanical angioplasty using a Gateway catheter combined with a low-dose thrombolytic agent is a safe and effective treatment for acute intracranial embolic and atherosclerotic occlusion with a low risk of hemorrhagic complications. Copyright © 2010 by the Congress of Neurological Surgeons. |
| spellingShingle | Tokunaga, K Sugiu, K Yoshino, K Terai, Y Imaoka, T Handa, A Hirotsune, N Kusaka, N Date, I Percutaneous balloon angioplasty for acute occlusion of intracranial arteries |
| title | Percutaneous balloon angioplasty for acute occlusion of intracranial arteries |
| title_full | Percutaneous balloon angioplasty for acute occlusion of intracranial arteries |
| title_fullStr | Percutaneous balloon angioplasty for acute occlusion of intracranial arteries |
| title_full_unstemmed | Percutaneous balloon angioplasty for acute occlusion of intracranial arteries |
| title_short | Percutaneous balloon angioplasty for acute occlusion of intracranial arteries |
| title_sort | percutaneous balloon angioplasty for acute occlusion of intracranial arteries |
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