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<meta name="DC.Title" content="Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2722" />
<meta name="DC.Date" content="2012-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2012 by American Journal of Neuroradiology. 
Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol.

MATERIALS AND METHODS: Sixteen consecutive patients with acute ischemic stroke due to CTO who had combined IV and IA or a single IA thrombolytic treatment were enrolled. The baseline characteristics and prognosis were described. The patients who did and did not develop a PH shortly after treatment were compared.

RESULTS: The mean age was 66.4 years, and the median initial NIHSS score was 17. The median dose of IA urokinase was 320,000 U, and recanalization (TICI grade II-III) was achieved in 12 patients (75%). However, 5 patients died and 10 patients had poor prognosis with mRS 5–6 at discharge. Six patients (37.5%) with a PH had a higher NIHSS score 1 day after treatment (26.7 versus 13.6, P = .002), and they had more frequent mortality (66.7% versus 10.0%, P = .018) and worse prognosis (mRS 5–6; 100% versus 40%, P = .016) at discharge than patients without PH.

CONCLUSIONS: Patients with CTO who received IA urokinase treatment based on a bridging protocol had a poor prognosis. The development of PH might affect this outcome.

ASPECTS
:   Alberta Stroke Program Early CT Score
CTO
:   carotid terminus occlusion
ECASS
:   European Cooperative Acute Stroke Study
IA
:   intra-arterial
EMS
:   Emergency Management of Stroke
ICH
:   intracranial hemorrhage
IMS
:   Interventional Management of Stroke
MELI
:   MCA-Embolism Local Fibrinolytic Intervention Trial
mRS
:   modified Rankin Scale
PH
:   parenchymal hematoma
PROACT
:   Prolyse in Acute Cerebral Thromboembolism
TICI
:   thrombolysis in cerebral ischemia" />
<meta name="DC.Contributor" content="J.S. Lee" />
<meta name="DC.Contributor" content="J.M. Hong" />
<meta name="DC.Contributor" content="E.J. Kim" />
<meta name="DC.Contributor" content="D.H. Shin" />
<meta name="DC.Contributor" content="I.S. Joo" />
<meta name="DC.Contributor" content="Y.C. Lim" />
<meta name="DC.Contributor" content="S.H. Suh" />
<meta name="DC.Contributor" content="S.Y. Kim" />
<meta name="article:published_time" content="2012-01-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Sixteen consecutive patients with acute ischemic stroke due to CTO who had combined IV and IA or a single IA thrombolytic treatment were enrolled. The baseline characteristics and prognosis were described. The patients who did and did not develop a PH shortly after treatment were compared.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The mean age was 66.4 years, and the median initial NIHSS score was 17. The median dose of IA urokinase was 320,000 U, and recanalization (TICI grade II-III) was achieved in 12 patients (75%). However, 5 patients died and 10 patients had poor prognosis with mRS 5–6 at discharge. Six patients (37.5%) with a PH had a higher NIHSS score 1 day after treatment (26.7 versus 13.6, &lt;i&gt;P&lt;/i&gt; = .002), and they had more frequent mortality (66.7% versus 10.0%, &lt;i&gt;P&lt;/i&gt; = .018) and worse prognosis (mRS 5–6; 100% versus 40%, &lt;i&gt;P&lt;/i&gt; = .016) at discharge than patients without PH.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Patients with CTO who received IA urokinase treatment based on a bridging protocol had a poor prognosis. The development of PH might affect this outcome.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="twitter:title" content="Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol.

MATERIALS AND METHODS: Sixteen consecutive patients with acute ischemic stroke due to CTO who had combined IV and IA or a single IA thrombolytic treatment were enrolled. The baseline characteristics and prognosis were described. The patients who did and did not develop a PH shortly after treatment were compared.

RESULTS: The mean age was 66.4 years, and the median initial NIHSS score was 17. The median dose of IA urokinase was 320,000 U, and recanalization (TICI grade II-III) was achieved in 12 patients (75%). However, 5 patients died and 10 patients had poor prognosis with mRS 5–6 at discharge. Six patients (37.5%) with a PH had a higher NIHSS score 1 day after treatment (26.7 versus 13.6, P = .002), and they had more frequent mortality (66.7% versus 10.0%, P = .018) and worse prognosis (mRS 5–6; 100% versus 40%, P = .016) at discharge than patients without PH.

CONCLUSIONS: Patients with CTO who received IA urokinase treatment based on a bridging protocol had a poor prognosis. The development of PH might affect this outcome.

ASPECTS
:   Alberta Stroke Program Early CT Score
CTO
:   carotid terminus occlusion
ECASS
:   European Cooperative Acute Stroke Study
IA
:   intra-arterial
EMS
:   Emergency Management of Stroke
ICH
:   intracranial hemorrhage
IMS
:   Interventional Management of Stroke
MELI
:   MCA-Embolism Local Fibrinolytic Intervention Trial
mRS
:   modified Rankin Scale
PH
:   parenchymal hematoma
PROACT
:   Prolyse in Acute Cerebral Thromboembolism
TICI
:   thrombolysis in cerebral ischemia" />
<meta name="og-title" property="og:title" content="Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/33/1/175" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol.

MATERIALS AND METHODS: Sixteen consecutive patients with acute ischemic stroke due to CTO who had combined IV and IA or a single IA thrombolytic treatment were enrolled. The baseline characteristics and prognosis were described. The patients who did and did not develop a PH shortly after treatment were compared.

RESULTS: The mean age was 66.4 years, and the median initial NIHSS score was 17. The median dose of IA urokinase was 320,000 U, and recanalization (TICI grade II-III) was achieved in 12 patients (75%). However, 5 patients died and 10 patients had poor prognosis with mRS 5–6 at discharge. Six patients (37.5%) with a PH had a higher NIHSS score 1 day after treatment (26.7 versus 13.6, P = .002), and they had more frequent mortality (66.7% versus 10.0%, P = .018) and worse prognosis (mRS 5–6; 100% versus 40%, P = .016) at discharge than patients without PH.

CONCLUSIONS: Patients with CTO who received IA urokinase treatment based on a bridging protocol had a poor prognosis. The development of PH might affect this outcome.

ASPECTS
:   Alberta Stroke Program Early CT Score
CTO
:   carotid terminus occlusion
ECASS
:   European Cooperative Acute Stroke Study
IA
:   intra-arterial
EMS
:   Emergency Management of Stroke
ICH
:   intracranial hemorrhage
IMS
:   Interventional Management of Stroke
MELI
:   MCA-Embolism Local Fibrinolytic Intervention Trial
mRS
:   modified Rankin Scale
PH
:   parenchymal hematoma
PROACT
:   Prolyse in Acute Cerebral Thromboembolism
TICI
:   thrombolysis in cerebral ischemia" />
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    <title>Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase | American Journal of Neuroradiology</title>  
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      <h1 class="highwire-cite-title" id="page-title">Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.S. Lee</span>, <span class="highwire-citation-author" data-delta="1">J.M. Hong</span>, <span class="highwire-citation-author" data-delta="2">E.J. Kim</span>, <span class="highwire-citation-author" data-delta="3">D.H. Shin</span>, <span class="highwire-citation-author" data-delta="4">I.S. Joo</span>, <span class="highwire-citation-author" data-delta="5">Y.C. Lim</span>, <span class="highwire-citation-author" data-delta="6">S.H. Suh</span> and <span class="highwire-citation-author" data-delta="7">S.Y. Kim</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2012,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">175-179; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2722 </span></div>
  
  
  
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      <div class="highwire-cite-title">Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.S.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Hong</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">E.J.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.H.</span> <span class="nlm-surname">Shin</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">I.S.</span> <span class="nlm-surname">Joo</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Y.C.</span> <span class="nlm-surname">Lim</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.H.</span> <span class="nlm-surname">Suh</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">S.Y.</span> <span class="nlm-surname">Kim</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2012, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">175-179; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2722 </span></div>
  
  
  
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      <div class="highwire-cite-title">Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.S.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Hong</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">E.J.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.H.</span> <span class="nlm-surname">Shin</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">I.S.</span> <span class="nlm-surname">Joo</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Y.C.</span> <span class="nlm-surname">Lim</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.H.</span> <span class="nlm-surname">Suh</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">S.Y.</span> <span class="nlm-surname">Kim</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2012, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">175-179; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2722 </span></div>
  
  
  
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