MR Imaging-Based Localized Intra-Arterial Thrombolysis Assisted by Mechanical Clot Disruption for Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion

BACKGROUND AND PURPOSE: LIT-MCD is used in our institution for acute stroke due to MCA occlusion, with the goal of reducing symptomatic intracranial hemorrhage by maintaining recanalization of the occluded vessels. The purpose of the study was to investigate the safety and efficacy of LIT-MCD and to identify factors associated with a poor outcome in patients undergoing this procedure. MATERIALS AND METHODS: LIT-MCD for MCA occlusion was performed in 90 of 1907 consecutive patients with acute stroke admitted to our institution. Radiographic data and clinical outcome were evaluated in the 90 patients, and factors predictive of a poor outcome (3-month mRS score, 3-6) were investigated by multivariate analysis. RESULTS: Recanalization was achieved in 73 of the 90 patients (81%); symptomatic intracranial hemorrhage occurred in 7 (8%); procedure-related complications, in 9 (10%), and a favorable clinical outcome (3-month mRS score, 0-2), in 48 (53%). A high baseline NIHSS score (>= 20), a low preprocedural ASPECTS on MR imaging (<= 7), proximal M1 occlusion (in the horizontal segment of the MCA at or proximal to the lenticulostriate arteries), and no recanalization were significant predictors of a poor clinical outcome. CONCLUSIONS: LIT-MCD is a safe and effective treatment for acute stroke due to MCA occlusion. However, further intervention is needed to improve the outcome of patients with proximal M1 occlusion.