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      Thromboembolic Occlusion of the Middle Cerebral Artery due to Angiography and Endovascular Procedures: Safety and Efficacy of Local Intra-Arterial Fibrinolysis

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          Abstract

          The purpose of this study was to evaluate the safety and efficacy of local intra-arterial fibrinolysis (LIF) in the treatment of thromboembolic MCA occlusions that occurred during angiography and/or endovascular procedures. A retrospective analysis included 14 consecutive cases of iatrogenic thromboembolic MCA occlusions, encountered between January, 1983 and December, 1994 in a single neuroradiological department. During that period, a total of approximately 12,000 cerebral angiographies and of 4,000 neuroendovascular procedures were performed. Only patients in whom vessel occlusion by an embolic agent (e.g., glue, particles) could be positively excluded were accepted. LIF was performed using standard microcatheters. The fibrinolytic agents were streptokinase or urokinase, in varying dosages. Immediate LIF resulted in a complete recanalization of the previously occluded vessel within 2 h or less in 8/14 patients, all of whom were asymptomatic at discharge. Partial recanalization was achieved in 5/14 patients. Four of these patients showed mild to moderate neurological deficits on discharge. In 1 patient, LIF was initiated 3 h after embolic occlusion of the MCA due to cerebral angiography. No recanalization was observed in this case. The patient improved from her initial status but continued to show moderate hemiparesis and aphasia. None of the patients sustained an intracranial hemorrhage due to LIF. Acute thromboembolic occlusion of the MCA is a rare consequence of angiography and endovascular therapy. LIF is a safe and effective tool in the treatment of this complication. Thus, LIF is an indispensable part of neuroendovascular procedures. The well-defined onset time and site of vessel occlusion, the angiographically charted effect of fibrinolytic therapy, and the possibility of following up these patients with angiography, MRI and clinical investigation are all factors which render this complication and its correction a unique clinical model for evaluating the benefits and limitations of LIF in the treatment of acute MCA occlusion.

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          Author and article information

          Journal
          CED
          Cerebrovasc Dis
          10.1159/issn.1015-9770
          Cerebrovascular Diseases
          S. Karger AG
          1015-9770
          1421-9786
          1996
          1996
          12 June 1996
          : 6
          : 4
          : 222-230
          Affiliations
          a Neurologische Klinik mit klinischer Neurophysiologie, b Klinik für Radiologische Diagnostik und Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen, Deutschland
          Article
          108100 Cerebrovasc Dis 1996;6:222–230
          10.1159/000108100
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 9
          Categories
          Original Paper

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