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1 Review Key Words : Stroke; Thrombolysis; Revasculaization treatment; Mechanical thrombolysis Received May 8, 2006; accepted after revision July 15, Correspondence to: Deok Hee Lee, MD, Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poognap-dong, Sonpa-gu, Seoul , Korea Tel Fax dhlee@amc.seoul.kr Neurointervention 2006;1: Neurointervention 1, August 2006

Correspondence to: Deok Hee Lee, MD, Department of Radiology, Research Institute of Radiology, Asan Medical Center,

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3 Fig. 1. Functional outcome represented as mrs and comparison of current domestic results with those of control and treated groups of major thrombolysis trials. Table 1. Univariate Relationships of Significant Hemorrhage after Thrombolysis Variable Odds Ratio P value Demographic Age (>65y) Sex (male) Diabetes Hypertension Cardioembolism Initial NIHSS score CT findings Positive early CT sign Violation of one-third rule Basal ganglia involvement Hyperdense MCA sign (+) MR findings DWI lesion over 1/3 of MCA territory DWI lesion over 1/2 of MCA territory Basal ganglia involvement Presence of diffusion-perfusion mismatch Visible dark clot on T2*-weighted images Procedure and post-procedure imaging findings Within working hours Within 3 hours after symptom onset Within 6 hours after symptom onset Combined IV thrombolysis Combined mechanical thrombolysis Failed recanalization Any contrast staining on post-ct 15.8 < Contrast extravasation on post-ct 14.9 < Table 2. Univariate Relationships with Poor Functional Outcome (mrs > 3) Variable Odds Ratio P value Demographic Age (>65y) Sex (male) Diabetes Hypertension Cardioembolism Initial NIHSS score < CT findings Positive early CT sign Violation of one-third rule Basal ganglia involvement Hyperdense MCA sign (+) MR findings DWI lesion over 1/3 of MCA territory DWI lesion over 1/2 of MCA territory Basal ganglia involvement Presence of diffusion-perfusion mismatch Visible dark clot on T2*-weighted images Procedure and post-procedure imaging findings Within working hours Within 3 hours after symptom onset Within 6 hours after symptom onset Combined IV thrombolysis Combined mechanical thrombolysis Failed recanalization Any contrast staining on post-ct Contrast extravasation on post-ct Significant hemorrhage Neurointervention 1, August 2006

044 Cardioembolism 1.38 0.51 Initial NIHSS score 15 3.75 0.046 CT findings Positive early CT sign 1.80 0.38 Violation of one-third rule 4.42 0.08 Basal ganglia involvement 4.08 0.

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11 1. Zeumer H, Hacke W, Ringelstein EB. Local intraarterial thrombolysis in vertebrobasilar thromboembolic disease. AJNR Am J Neuroradiol 1983;4: Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt-pa stroke study group. N Engl J Med 1995;333: Cho HK, Chung TS, Kim DI, Suh JH, Lee BI, Lee BC. Intracarotid urokinase thrombolytic therapy in acute cerebral infarction: A preliminary study. J Kor Radiol Societ 1990;26: Kim SY, Suh JH. Local intracranial intraarterial thrombolytic therapy in acute cerebral infarction. J Korean Radiol Soc 1996;34: Shi HB, Suh DC, Lim SM, Lee JH, Kim JK, Jeong AK, Choi CG, Lee HK, Lim TH, Auh YH. Outcome evaluation of intra-arterial infusion of urokinase for acute ischemic stroke. J Korean Radiol Soc 2000;42: Song JM, Yoon W, Kim JK, Seo JJ, Heo SH, Park JK, Jeong YY, Kang HK. Influential factors of clinical outcome of local intraarterial thrombolysis using urokinase in patients with hyperacute ischemic stroke. J Korean Radiol Soc 2002;47: Ng PP, Higashida RT, Cullen SP, Malek R, Dowd CF, Halbach VV. Intraarterial thrombolysis trials in acute ischemic stroke. J Vasc Interv Radiol 2004;15:S del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M. Proact: A phase ii randomized trial of recombinant prourokinase by direct arterial delivery in acute middle cerebral artery stroke. Proact investigators. Prolyse in acute cerebral thromboembolism. Stroke 1998;29: Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F. Intra-arterial prourokinase for acute ischemic stroke. The proact ii study: A randomized controlled trial. Prolyse in acute cerebral thromboembolism. Jama 1999;282: Intraarterial thrombolysis: Ready for prime time? Executive committee of the asitn. 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Cho HK, Chung TS, Kim DI, Suh JH, Lee BI, Lee BC. Intracarotid urokinase thrombolytic therapy in acute cerebral infarction: A preliminary study. J Kor Radiol Societ 1990;26:609-617 4. Kim SY, Suh JH.

12 Stroke 2004;35: Lee KY, Kim DI, Kim SH, Lee SI, Chung HW, Shim YW, Kim SM, Heo JH. Sequential combination of intravenous recombinant tissue plasminogen activator and intra-arterial urokinase in acute ischemic stroke. AJNR Am J Neuroradiol 2004;25: Lee DH, Jo KD, Kim HG, Choi SJ, Jung SM, Ryu DS, Park MS. Local intraarterial urokinase thrombolysis of acute ischemic stroke with or without intravenous abciximab: A pilot study. J Vasc Interv Radiol 2002;13: Mangiafico S, Cellerini M, Nencini P, Gensini G, Inzitari D. Intravenous tirofiban with intra-arterial urokinase and mechanical thrombolysis in stroke: Preliminary experience in 11 cases. Stroke 2005;36: Kwon OK, Lee KJ, Han MH, Oh CW, Han DH, Koh YC. Intraarterially administered abciximab as an adjuvant thrombolytic therapy: Report of three cases. AJNR Am J Neuroradiol 2002;23: Nakano S, Iseda T, Yoneyama T, Kawano H, Wakisaka S. Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: An alternative option to intra-arterial thrombolysis. Stroke 2002;33: Coutts SB, Hill MD, Hu WY. Hyperperfusion syndrome: Toward a stricter definition. Neurosurgery 2003;53: ; discussion Imai K, Mori T, Izumoto H, Watanabe M, Majima K. Emergency carotid artery stent placement in patients with acute ischemic stroke. AJNR Am J Neuroradiol 2005;26: Nedeltchev K, Brekenfeld C, Remonda L, Ozdoba C, Do DD, Arnold M, Mattle HP, Schroth G. Internal carotid artery stent implantation in 25 patients with acute stroke: Preliminary results. Radiology 2005;237: Molina CA, Saver JL. Extending reperfusion therapy for acute ischemic stroke: emerging pharmacological, mechanical, and imaging strategies. Stroke 2005;36: Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi mechanical embolus removal in cerebral ischemia (merci) trial, part i. AJNR Am J Neuroradiol 2006;27: Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, Lutsep HL, Nesbit GM, Grobelny T, Rymer MM, Silverman IE, Higashida RT, Budzik RF, Marks MP. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: Results of the merci trial. Stroke 2005;36: Nesbit GM, Luh G, Tien R, Barnwell SL. New and future endovascular treatment strategies for acute ischemic stroke. J Vasc Interv Radiol 2004;15:S Schumacher HC, Meyers PM, Yavagal DR, Harel NY, Elkind MS, Mohr JP, Pile-Spellman J. Endovascular mechanical thrombectomy of an occluded superior division branch of the left mca for acute cardioembolic stroke. Cardiovasc Intervent Radiol 2003;26: Davis SM, Donnan GA. Merci retriever: Does it work? Stroke 2006;37: Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, Montaner J, Saqqur M, Demchuk AM, Moye LA, Hill MD, Wojner AW. Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med. 2004;351: Mahon BR, Nesbit GM, Barnwell SL, Clark W, Marotta TR, Weill A, Teal PA, Qureshi AI. North american clinical experience with the ekos microlysus infusion catheter for the treatment of embolic stroke. AJNR Am J Neuroradiol 2003;24: Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK. Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke. Stroke 2004;35: Neurointervention 1, August

Lee DH, Jo KD, Kim HG, Choi SJ, Jung SM, Ryu DS, Park MS. Local intraarterial urokinase thrombolysis of acute ischemic stroke with or without intravenous abciximab: A pilot study.

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical