Percutaneous balloon angioplasty for acute occlusion of intracranial arteries.

Journal Article (Journal Article;Multicenter Study)

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 x 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.

Full Text

Duke Authors

Cited Authors

  • Tokunaga, K; Sugiu, K; Yoshino, K; Terai, Y; Imaoka, T; Handa, A; Hirotsune, N; Kusaka, N; Date, I

Published Date

  • September 2010

Published In

Volume / Issue

  • 67 / 3 Suppl Operative

Start / End Page

  • ons189 - ons196

PubMed ID

  • 20679930

Electronic International Standard Serial Number (EISSN)

  • 1524-4040

Digital Object Identifier (DOI)

  • 10.1227/01.NEU.0000380954.29925.CE


  • eng

Conference Location

  • United States