Findings: (First Image)PA view of left internal carotid artery (ICA) injection demonstrates occlusion of the distal M1 segment of the middle cerebral artery (MCA). (Second Image) A tracker catheter has been placed through the clot, into the MCA.(Third Image) PA view of a left ICA injection, after the administration of 500,000 units of intra-arterial urokinase, demonstates normal filling of the left MCA and its branches.
Diagnosis: Stroke (Brain Attack)
Discussion: Stroke is the leading cause of life-threatening neurologic disease and the third leading cause of death in the United States, with an incidence of 500,000 cases per year. In the past there was no effective treatment. Recently intra-arterial thrombolysis has emerged as a promising treatment for strokes. At University Hospitals of Cleveland, in a trial of intra-arterial urokinase, 85% of patients showed angiographic evidence of recanalization and 61% showed excellent or good neurologic improvement. A 15% complication rate and 15% death rate was noted however. Further studies will be needed to prove whether this is an effective treatment.
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