Local fibrinolysis for middle cerebral artery embolism. Criteria for the indication by evaluation of residual cerebral blood flow and the results.

SUMMARY: We summarize our clinical experience of the local fibrinolysis for the middle cerebral artery (MCA) embolism.We added residual CBF factors of the ischemic territories to the usual criteria for the indication of fibrinolysis by Xe-SPECT CBF measurement. Forty-nine cases of local fibrinolysis for MCA embolism were reviewed and the results were compared with the conservative medical treatment cases. Angiographical improvements were achieved in 38 cases (76%, full reopening 17/49, partial reopening 21/49) and favorable outcomes (good recovery at GOS) were obtained in 32 cases (65%) at three months follow-up outcome. In comparison with the conservative medical treatment, fibrinolysis was superior at good recovery rate, severe disability rate and the resulted large infarction rate with statistical significance. We concluded that the local fibrinolysis with evaluation of the residual CBF of the ischemic territories achieved good results and outcomes and superior to the conservative medical treatment at some points. To keep the therapeutic time window, it is necessary to include the CBF factor to the criteria for the indication of this treatment.