Address of Corresponding Author

Cerebrovasc Dis 2005;19:225-228 (DOI: 10.1159/000083887)

  Key Words

• Intra-arterial urokinase thrombolysis
• Cardioembolic stroke
• Acute ischemic stroke
• National Institute of Health Stroke Scale score
• Modified Rankin scale score

  Abstract

Background: Intra-arterial urokinase (IA-UK) thrombolysis is frequently given in Japan to selected patients with acute cerebral artery occlusion. However, it is not clear whether or not IA-UK thrombolysis has an efficacy for acute stroke patients. The purpose of this study was to assess the effects of IA-UK thrombolysis in acute cardioembolic stroke patients, by performing a case-control analysis using data from Japan's Multicenter Stroke Investigator's Collaboration (J-MUSIC). Methods: 16,922 acute ischemic stroke patients were enrolled into J-MUSIC. From these patients, we selected 91 patients (UK group) who met the following criteria: treatment with IA-UK; 20-75 years of age; cardioembolic stroke; presenting with a carotid stroke; admission within 4.5 h of symptom onset, and a National Institutes of Health Stroke Scale (NIHSS) score of 5-22 points on admission. A control group of 182 patients without IA-UK treatment and matched to the NIHSS score, gender, and age was chosen. We compared the modified Rankin scale (mRS) score at discharge and the mortality between the 2 groups. Results: In both groups, the mean age was 65 ± 8 years, and the median NIHSS score was 14. The mean interval between symptom onset and UK administration was 3.4 ± 1.3 h, and the IA-UK dose was 392,000 ± 200,000 units. The mRS score at discharge was lower in the UK group than in the control group (mean, SD, median; 2.8, 2.9, 2 in UK group vs. 3.3, 1.8, 4, in the control, respectively p = 0.031). A favorable outcome (mRS of 0-2) was more frequently observed in the UK group (50.5%) than in the control group (34.1%, p = 0.0124). No difference in the mortality rate was seen between the UK group (11.0%) and the control group (13.3%). As well, there was no difference in the length of hospital stay between the UK group (46 ± 41 days, mean ± SD) and the control group (42 ± 42 days, mean ± SD). Conclusions: IA-UK thrombolytic therapy may improve the outcome in hyperacute cardioembolic stroke patients.

Copyright © 2005 S. Karger AG, Basel

  Author Contacts

Takeshi Inoue, MD
Cerebrovascular Division, Department of Medicine, Kawasaki Medical School
577 Matsushima
Kurashiki-City, Okayama, 701-0192 (Japan)
Tel. +81 86 462 1111, Fax +81 86 464 1027, E-Mail inouet@med.kawasaki-m.ac.jp

  Article Information

Received: April 1, 2004
Accepted: October 5, 2004
Published online: February 8, 2005
Number of Print Pages : 4
Number of Figures : 1, Number of Tables : 1, Number of References : 20