A comparison of efficacy of carotid artery thrombolysis and venous thrombolysis with urokinase in acute cerebral infarction

Objective:To evaluate the safety and efficacy of urokinase in carotid or venous thrombolysis in patients with acute ischemic stroke of anterior cerebral circulation,and to determine its impact on clinical outcome.Methods:38 patients(group A) were treated with carotid thrombolysis using urokinase 〔median dose,(50100)×10 4 U〕,and 30 patients (group B) with venous thrombolysis〔urokinase(100250)×10 4 U〕.The European Stroke Scale(ESS) score was assessed at hospital admission,second hour,second day,seventh day and fourteenth day after treatment.Results:After 2 hours of treatment,the use of urokinase proved to be effective in 32 patients (84 21%) in group A,of whom 7 cases (18 42%) met the criteria of clinical cure.The use of urokinase was effective in 25 ( 83 33%) patients in group B and no patients met the criteria of clinical cure.After 14 days of treatment,it proved to be effective in 35 patients (92 11%) in group A and 24 cases (63 16%) met the criteria of clinical cure in group A,whereas it was effective in 29 cases (96 67%) and 10 cases (33 33%) met the criteria of clinical cure in group B.Good outcome was associated with a better initial score and early treatment.Symptomatic cerebral hemorrhage occurred in 1 patient only (2 63%),who was treated with arterial thrombolysis,and mild systemic hemorrhage occurred in 5 patients (16 67%) in patients with venous thrombolysis.Conclusions:Carotid thrombolysis using urokinase is efficacious and relatively safe in patients with cerebral infarction when the initial neurological deficency score is not too bad and when treated within 12 hours.Carotid thrombolysis give a better result than venous thrombolysis.