Treatment of Selected Cases of Acute Ischemic Stroke with Intrarterial Thrombolysis and Intracranial Stenting; Report of Ten Cases

Globally, stroke is one of the leading causes of death and disability. The most common type is ischemic stroke. Despite all socioeconomic impacts, there is no efficacious treatment for this devastating disease. Due to limited time window and other obstacles only small numbers of patients are eligible for new treatment like intravenous thrombolytic treatment. Other type of interventions like intra-arterial thrombolysis, retrieval devices are useful in selected cases. In this study we presented ten different cases of acute ischemic stroke treated by intra-arterial thrombolysis and/or stenting.

Ten consecutive patients presented with symptoms and signs of intracranial artery occlusion within 6 and 18 hours respectively for anterior and posterior circulation were treated with intra-arterial thrombolytic (10-20 mg tissue plasminogen activator or Tpa) and stenting. A neurologist obtained the national institutes of health stroke scale (NIHSS) at baseline, and 2 hours, 24 hours, 7 days and 3 months after treatment.

Ten patients (6 men and 4 women) aged 23 to 74 years were recruited. Eight patients presented with stroke in the anterior circulation territory and two with posterior one. We achieved complete recanalization in 7 patients (70%) and partial in one case (10%) and in two patients with T-type left internal carotid occlusion recanalization was unsuccessful (20%). Clinical improvement and neurological recovery in the patients with complete recanalization was excellent

These results support the efficacy of intrarterial thrombolysis and stenting in the treatment of selected cases of acute stroke ischemic. In patients with T-type carotid occlusion, this type of treatment did not show significant clinical benefits.