Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease.

In this retrospective analysis we report our treatment experience in 65 consecutive patients with clinical signs of severe brainstem ischemia with angiographically demonstrated thrombotic vertebrobasilar artery occlusions who received either local intra-arterial thrombolytic therapy (urokinase or streptokinase) (43 patients) or conventional therapy (antiplatelet agents or anticoagulants) (22 patients). We analyzed the data with respect to cerebral artery occlusion patterns, posttreatment arterial recanalization, and the clinical categories of favorable/unfavorable outcome and survival/death. In subgroup analyses, recanalization in patients who received thrombolytic therapy correlated significantly with clinical outcome; in 19 of 43 patients, recanalization was demonstrated angiographically, while in 24 patients the occlusion persisted. All patients without recanalization died, but 14 of the 19 patients displaying recanalization survived (p = 0.000007), 10 with a favorable clinical outcome. Only three of the 22 patients who received conventional therapy survived, all with a moderate clinical deficit. When we compared the treatment groups, highly significant differences in both outcome quality (p = 0.017) and survival (p = 0.0005) were found to depend on establishing recanalization. Our data support the concept that technically successful thrombolysis of vertebrobasilar artery occlusions is associated with beneficial clinical outcome.

[1]  R. Adams,et al.  Occlusion of the basilar artery; a clinical and pathological study. , 1946, Brain : a journal of neurology.

[2]  A. Biemond Thrombosis of the basilar artery and the vascularization of the brain stem. , 1951, Brain : a journal of neurology.

[3]  R. L. Clarke,et al.  The treatment of cerebrovascular thromboses and embolism with fibrinolytic agents. , 1960, The American journal of cardiology.

[4]  L. Nahum Therapeutic thrombolysis. , 1961, Connecticut medicine.

[5]  W. S. Fields,et al.  Survival following basilar artery occlusion. , 1966, Archives of neurology.

[6]  C. Fisher Occlusion of the vertebral arteries. Causing transient basilar symptoms. , 1970, Archives of neurology.

[7]  C. Derouesné,et al.  Arterial occlusions in the vertebro-basilar system. A study of 44 patients with post-mortem data. , 1973, Brain : a journal of neurology.

[8]  H. Hurtig,et al.  "Locked-in" state with bilateral midbrain infarcts. , 1974, Archives of neurology.

[9]  M. Raichle,et al.  A Pilot Study of Urokinase Therapy in Cerebral Infarction , 1976, Stroke.

[10]  C. Archer,et al.  Basilar Artery Occlusion Clinical and Radiological Correlation , 1977, Stroke.

[11]  J. Taveras,et al.  Cerebral angiography in acute cerebral infarction. , 1977, Revista interamericana de radiologia.

[12]  C. Fisher Bilateral occlusion of basilar artery branches. , 1977, Journal of neurology, neurosurgery, and psychiatry.

[13]  L. Caplan Occlusion of the Vertebral or Basilar Artery: Follow Up Analysis of Some Patients with Benign Outcome , 1979, Stroke.

[14]  L. Caplan “Top of the basilar” syndrome , 1980, Neurology.

[15]  R. Hobbs,et al.  Risk of hemorrhage and timing of anticoagulation after nonseptic embolic brain infarction , 1981 .

[16]  G. Clagett,et al.  Platelet changes after placement of aortic prostheses in dogs. II. Impaired surface-induced arterial thrombosis. , 1981, The Journal of laboratory and clinical medicine.

[17]  G. Clagett,et al.  Platelet changes after placement of aortic prostheses in dogs. I. Biochemical and functional alterations. , 1981, The Journal of laboratory and clinical medicine.

[18]  W. Hacke,et al.  [Local fibrinolysis in basilar artery thrombosis (author's transl)]. , 2008, Deutsche medizinische Wochenschrift.

[19]  M. Modic,et al.  Hemorrhage and anticoagulation after nonseptic embolic brain infarction , 1982, Neurology.

[20]  E. Ringelstein,et al.  Local intraarterial thrombolysis in vertebrobasilar thromboembolic disease. , 1983, AJNR. American journal of neuroradiology.

[21]  J L Ritchie,et al.  Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. , 1983, The New England journal of medicine.

[22]  L. Caplan Bilateral distal vertebral artery occlusion , 1983, Neurology.

[23]  W. Hacke,et al.  Brain-stem evoked potentials (BAEP) and somatosensory evoked potentials (SEP) in basilar artery occlusion , 1985 .

[24]  K. Zülch,et al.  The Cerebral Infarct: Pathology, Pathogenesis, and Computed Tomography , 1985 .

[25]  K. Zülch The Cerebral Infarct , 1985 .

[26]  H. Zeumer,et al.  Thrombolytic therapy in stroke: possibilities and hazards. , 1986, Stroke.

[27]  T. Waltz,et al.  Experimental acute thrombotic stroke in baboons. , 1986, Stroke.

[28]  J. Bogousslavsky,et al.  Bilateral occlusion of vertebral artery , 1986, Neurology.

[29]  W. Hacke,et al.  Acute vertebral-basilar thrombosis. Angiologic-clinical comparison and therapeutic implications. , 1986, Acta radiologica. Supplementum.

[30]  W. Hacke,et al.  INTRA-ARTERIAL THROMBOLYTIC THERAPY IN ACUTE MIDDLE CEREBRAL ARTERY STROKE , 1987 .

[31]  W. Hacke,et al.  Thrombosis and Cerebrovascular Disease , 1987 .

[32]  E. Ringelstein,et al.  New Trends in Diagnosis and Management of Stroke , 1987, Springer Berlin Heidelberg.

[33]  S. Biedert,et al.  Directional C—W Doppler Sonography in the Diagnosis of Basilar Artery Disease , 1987, Stroke.

[34]  W. Hacke,et al.  Local intra-arterial fibrinolytic therapy in acute carotid territory stroke. A pilot study. , 1988, Stroke.

[35]  H. Barnett,et al.  Stroke : pathophysiology, diagnosis, and management , 1998 .