Indications for acute focal thrombolytic therapy of carotid embolism.
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Thirty-two patients with carotid embolism were studied to clarify the indications and problems of acute focal thrombolytic therapy for embolism in the anterior circulation. Of that, 26 patients had thrombolysis and 6 did not. Urokinase was used as the thrombolytic agent in 20 patients and tissue plasminogen activator (t-PA) was used in 6 patients. It took two to twelve hours (mean 4.5 hours) to recanalize or complete the treatment. The occlusion level was the terminal portion of the internal carotid artery (ICA) in 9 patients, the proximal M1 portion of middle cerebral artery (MCA) in 5, the distal portion of M1 in 11 and the M2-M3 portion in 7 patients. Nineteen of 26 patients (73%) were successfully recanalized. Thirteen of 14 patients with occlusion in the level of terminal ICA and proximal M1 portion presented with extensive hemispheric infarction and the severe neurological deficits regardless of recanalization. Of 18 patients with occlusion of the distal M1 portion and branches of MCA, 11 patients with recanalization showed dramatic improvement in symptoms, and seven patients without recanalization developed persistent neurological deficits. In conclusion, the indication of acute thrombolysis should be limited to embolism in the distal M1 portion or more peripheral branches of MCA. Recanalization for occlusion of the terminal ICA and proximal M1 portion may be risky because of postprocedural cerebral swelling and hemorrhage, and may have no merit based on functional prognosis.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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