I. Petrov, M. Klissurski, S. Sirakov, B. Zehirov, A. Mihaylov, D. Petkova, Ts. Pramatarova, T. Kmetski, G. Georgieva-Kozarova, L. Penev, L. Grozdinski
City Clinic Cardiology Center MPHAC – Sofia, Bulgaria
Objective: To report the clinical, radiological, and haemodynamic data of three patients with AIS who underwent IAT.
Material and Methods: Two men and one woman, mean age of 61.6, two with MCA occlusion and one with posterior AIS, were treated. Clinical outcome was assessed according to NIHSS and mRS on day 1, 30 and 90. Neuroimaging included non-contrast CT or MRI, diffusion and angio MRI. All patients underwent cerebral angiography and met criteria for endovascular TL. Transcranial duplex scanning was used for haemodynamic assessment of the occlusion and recanalization. Actiyse was infused supraselectively via microcatheter in a mean dose of 38.3 mg. TICI score was documented at the end of the procedure. Post-procedural I.V. 24 h heparin infusion was given to one patient with poor TICI result.
Results: All patients had embolic AIS. Mean time from symptoms onset to start of IAT was 175 min. Mean initial NIHSS was 14.6. Diffusion MRI demonstrated large MCA territory lesion > 1/3 in 1 patient, and small zones in 2 other. TICI scores were 2b, 3, 1. None of the patients had iatrogenic haemorrhage. Ultrasound monitoring showed recanalization immediately after the procedure in 2 patients, and 3 hours later in 1 patient. On control vascular imaging, that result was stable on the second day. Control CT revealed an infarct area with edema only in one patient. Mean NIHSS score on day 7 was 6, on day 30 was 4.6. Mean mRS on day 7 was 3, on day 30 was 2.
Discussion: Important determinants for success were time to IAT, stroke severity, and age. We observed excellent early ultrasound results and clinical outcome in 2 patients, as well as mild to moderate in one. No serious complications were noted despite non-consensus type of treatment. Future research and protocol improvement of IAT is needed to validate the best individual treatment approach.
Key words: endovascular therapy, intra-arterial treatment, stroke, thrombolysis.