Blood pressure in the artery distal to an intraarterial embolus during thrombolytic therapy for occlusion of a major artery: a predictor of cerebral infarction following good recanalization

Abstract

Back pressure measurement in combination with DW MR imaging can be used to predict the occurrence of infarction as demonstrated on CT scans following thrombolysis.

Blood pressure measurement in the artery proximal and distal to an intra-arterial embolus during thrombolytic therapy

“…Intra-arterial thrombolysis with mechanical disruption using a microcatheter and a guide wire was started between 60 and 360 min (mean±SD, 211±58.4 min) after the onset of symptoms. We previously reported the methodological details of thrombolysis with mechanical disruption 12 13. During this procedure, the blood pressure was measured in intracranial arteries just distal and proximal to the embolus.…”

“…Superselective angiography from the microcatheter was performed to assess the precise site of occlusion and the size of the embolus. Then, the arterial pressure just distal to the embolus (distal blood pressure) was measured by connecting the microcatheter to a pressure transducer (Model DX-312; Nihon Koden Co., Tokyo, Japan) and digital pressure monitor (Model KC-013P; Nihon Koden Co.) 12 14. When the distal end of the embolus was located in the M2 portion of the MCA, blood pressure was measured in the M2 supplying mainly to the parietal lobe.…”

“…We obtained two measurements for blood pressure through a microcatheter in the artery, in the regions just proximal and distal to the emboli during intra-arterial thrombolytic therapy for occlusion of a major artery. We reported that the blood pressure distal to the embolus was significantly lower in patients with bad outcomes compared with those with good outcomes 12. To the best of our knowledge, the blood pressure measured in the region proximal to an embolus has never been demonstrated before, and therefore, the hydromechanical force, which is a blood pressure gradient between the proximal and the distal sites to the embolus, has never been confirmed.…”

Long-Term Follow Up of Patients With Good Outcome After Intra-arterial Thrombolysis for Major Arterial Occlusion in the Carotid Territory: Clinical and Magnetic Resonance Imaging Evaluation

“…The details of thrombolysis using urokinase with mechanical disruption via a microcatheter and a guidewire have been described previously. 15,16) Arterial recanalization was evaluated using digital subtraction angiography at the end of thrombolytic therapy. Recanalization of the M 3 or more distal arteries was achieved in 11 of the 15 patients with occlusion of the distal ICA, and in all 23 patients with occlusion of the proximal MCA within 6 hours of the onset.…”

“…7) We achieved good recanalization rates of occluded major arteries in the carotid territory using intraarterial thrombolysis with mechanical clot disruption. 15,16) Approximately 70% of patients with occlusion of the proximal middle cerebral artery (MCA) and 30% of patients with occlusion of the internal carotid artery (ICA) became independent in activities of daily living. Good outcomes included improvement of paresis and/or aphasia after the treatment, but some patients continued to suffer shortstepped gait, masked face, and/or depression.…”