Embolic Intracranial Strokes: Catheter-Directed Thrombolysis

  • Maxim Mokin
  • Shady Jahshan
  • Travis M. Dumont
  • Elad I. Levy


In the setting of acute ischemic stroke, an intra-arterial (IA) pharmacological approach allows catheter-directed delivery of thrombolytic agents to the clot, offering several potential advantages by comparison with systemic (intravenous, IV) thrombolysis. First, a smaller dose of thrombolytic agent is utilized, thereby minimizing systemic hemorrhagic side effects; at the same time, a high concentration of the agent is locally delivered to the occlusion site. Second, using direct fluoroscopic guidance, a microcatheter can be placed immediately next to or directly into the thrombus. Third, both continuous and bolus delivery of thrombolytics can be given, based on specific features of the clot and the degree of response to lysis, which can be directly visualized during a microcatheter angiogram. IA thrombolysis can be used for thrombi located within smaller vessels, such as distal M2 or M3 branches of the middle cerebral artery (MCA), which often cannot be reached with mechanical thrombectomy devices. The angiographic appearance of a normal intracranial arterial anatomy is shown in Fig. 2.1.


Acute Ischemic Stroke Stroke Onset Thrombolytic Agent European Cooperative Acute Stroke Study Bolus Delivery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Activated coagulation time




Cerebral blood flow


Cerebral blood volume


Computed tomographic


European Cooperative Acute Stroke Study


Food and Drug Administration






Internal carotid artery


Intracranial hemorrhage


Interventional Management of Stroke




Middle cerebral artery


Mean transit time


National Institutes of Health Stroke Scale


National Institute of Neurological Disorders and Stroke


Prolyse in Acute Cerebral Thromboembolism


Partial thromboplastin time


Recombinant tissue plasminogen activator


FR™ With the Intention For Thrombectomy (SWIFT)


Thrombolysis in Myocardial Infarction


Tissue plasminogen activator




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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Maxim Mokin
    • 1
    • 2
    • 3
  • Shady Jahshan
    • 1
    • 2
    • 4
  • Travis M. Dumont
    • 1
    • 2
  • Elad I. Levy
    • 2
    • 5
    • 6
  1. 1.Department of Neurosurgery, School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA
  2. 2.Department of NeurosurgeryGates Vascular Institute, Kaleida HealthBuffaloUSA
  3. 3.Department of NeurosurgeryUniversity at Buffalo NeurosurgeryBuffaloUSA
  4. 4.Stroke Intervention Unit, The Tel-Aviv Sourasky Medical CenterTel-AviIsrael
  5. 5.Department of Neurosurgery and Department of Radiology, School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA
  6. 6.Toshiba Stroke Research Center, School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA

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