Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 58, Num. 3, 2010, pp. 504-505

Neurology India, Vol. 58, No. 3, May-June, 2010, pp. 504-505

Correspondence

Intra-arterial thrombolysis in acute ischemic stroke

S Aaron

Department of Neurological Sciences, Neurology Unit, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
Correspondence Address: S Aaron, Department of Neurological Sciences, Neurology Unit, Christian Medical College & Hospital, Vellore, Tamil Nadu, India, drsanjith@yahoo.co.uk

Date of Acceptance: 17-Jun-2010

Code Number: ni10136

PMID: 20644301
DOI: 10.4103/0028-3886.65544

Sir,

I read with interest the article "Intraarterial thrombolysis in acute ischemic stroke: A single center experience." ^[1] I have a few concerns: In this retrospective study, all the patients with acute ischemic stroke (< 6 h) fulfilling the inclusion and exclusion criteria were subjected to 4-vessel diagnostic cerebral angiography to establish the large vessel occlusion. Why was a noninvasive test, such as computed tomography, angiogram, or magnetic resonance angiogram not considered to look for large vessel occlusions? Also the authors have not mentioned how many patients with acute ischemic stroke were screened with angiogram while thrombolysing the 17 patients.

The authors for the last 5 years have been using tPA tissue plasminogen activator instead of urokinase for intraarterial thrombolysis (IAT). They have quoted a study ^[2] supporting recombinant tissue plasminogen activator (rtPA) use over urokinase; however, in this article no statistically significant differences were proved between the 2 types of fibrinolytic agents. Urokinase may be a better option in subsets of patients with embolic strokes where, heparin therapy can be initiated earlier than in those who had rtPA to prevent recurrence.

Other studies have shown the time of onset of symptom to recanalization to be the most important factor in determining the outcome after IAT. ^[3],[4] In this study, the authors should have mentioned the time from onset of the stroke till IA infusion was initiated and its influence on the outcome.

References

1.	Huded V, Dhomne S, Shrivastava M, Saraf R, Limaye U. Intra-arterial thrombolysis in acute ischemic stroke: A single center experience. Neurol India 2009;57:764-7.  Back to cited text no. 1  [PUBMED]
2.	Eckert B, Kucinski T, Pfeiffer G, Groden C, Zeumer H. Endovascular therapy of acute vertebrobasilar occlusion: Early treatment onset as the most important factor. Cerebrovasc Dis 2002;14:42-50.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.	Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACTII study: A randomized controlled trial: Prolyse in acute cerebral thromboembolism. JAMA 1999;282:2003-11.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Gonner F, Remonda L, Mattle H, Sturzenegger M, Ozdoba C, Lovblad KO, et al. Local intra-arterial thrombolysis in acute ischemic stroke. Stroke 1998;29:1894-900.  Back to cited text no. 4

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