American Journal of Neuroradiology, Vol 17, Issue 2 255-262, Copyright © 1996 by American Society of Neuroradiology
ARTICLES |
Intraarterial thrombolysis in vertebrobasilar occlusion
KJ Becker, LH Monsein, J Ulatowski, M Mirski, M Williams and DF Hanley
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
PURPOSE: To report our experience using intraarterial thrombolysis in the treatment of vertebrobasilar occlusion. METHODS: Twelve patients with 13 angiographically proved thromboses of the vertebrobasilar system underwent local intraarterial thrombolysis with urokinase. Angiographic and clinical outcomes were analyzed with respect to clinical examination at presentation, arterial occlusion patterns, and time to recanalization. RESULTS: The overall mortality was 75%. Recanalization could not be achieved in 3 of 13 treatments; all patients in whom recanalization failed died. The mortality rate was 60% in those patients in whom recanalization was successful. Coma or quadriparesis at the time of therapy uniformly predicted death. There were two cases each of bilateral proximal vertebral occlusions and midbasilar occlusions and nine cases of bilateral distal vertebral occlusions. There were three cases of fatal rethrombosis after initial successful thrombolysis. The mortality rate in the recanalized group before rethrombosis was 30%. There were two fatal hemorrhages of the central nervous system. CONCLUSION: Recanalization of the vertebrobasilar system is necessary but not sufficient for effective treatment of vertebrobasilar occlusive disease. The site of occlusion may help predict angiographic and clinical outcome. Time to initiation of thrombolysis is not an invariable correlate of survival, although clinical condition at presentation may be. Rethrombosis and hemorrhage are significant problems affecting mortality after successful thrombolysis.
This article has been cited by other articles:
 |
|
 |
|
  W. S. Smith Intra-Arterial Thrombolytic Therapy for Acute Basilar Occlusion: Pro Stroke, February 1, 2007; 38(2): 701 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Schulte-Altedorneburg, G.F. Hamann, M. Mull, D. Kuhne, M. Liebetrau, W. Weber, H. Bruckmann, and T.E. Mayer Outcome of Acute Vertebrobasilar Occlusions Treated with Intra-Arterial Fibrinolysis in 180 Patients AJNR Am. J. Neuroradiol., November 1, 2006; 27(10): 2042 - 2047. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bergui, G. Stura, D. Daniele, P. Cerrato, M. Berardino, and G. B. Bradac Mechanical Thrombolysis in Ischemic Stroke Attributable to Basilar Artery Occlusion as First-Line Treatment Stroke, January 1, 2006; 37(1): 145 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Favrole, J P Saint-Maurice, M G Bousser, and E Houdart Use of mechanical extraction devices in basilar artery occlusion J. Neurol. Neurosurg. Psychiatry, October 1, 2005; 76(10): 1462 - 1464. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. E. Mayer, G. F. Hamann, G. Schulte-Altedorneburg, and H. Bruckmann Treatment of Vertebrobasilar Occlusion by Using a Coronary Waterjet Thrombectomy Device: A Pilot Study AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1389 - 1394. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Arnold, K Nedeltchev, G Schroth, R W Baumgartner, L Remonda, T J Loher, F Stepper, M Sturzenegger, B Schuknecht, and H P Mattle Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis J. Neurol. Neurosurg. Psychiatry, June 1, 2004; 75(6): 857 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Yu, D. Binder, A. Foster-Barber, R. Malek, W. S. Smith, and R. T. Higashida Endovascular embolectomy of acute basilar artery occlusion Neurology, November 25, 2003; 61(10): 1421 - 1423. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Provenzale, R. Jahan, T. P. Naidich, and A. J. Fox Assessment of the Patient with Hyperacute Stroke: Imaging and Therapy Radiology, November 1, 2003; 229(2): 347 - 359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. D. M. Lin, P. Gailloud, N. J. Beauchamp, E. M. Aldrich, R. J. Wityk, and K. J. Murphy Combined Stent Placement and Thrombolysis in Acute Vertebrobasilar Ischemic Stroke AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1827 - 1833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status Stroke, February 1, 2003; 34(2): 575 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Lisboa, B. D. Jovanovic, and M. J. Alberts Analysis of the Safety and Efficacy of Intra-Arterial Thrombolytic Therapy in Ischemic Stroke Stroke, December 1, 2002; 33(12): 2866 - 2871. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. Mayer, G. F. Hamann, and H. Brueckmann Mechanical Extraction of a Basilar-Artery Embolus with the Use of Flow Reversal and a Microbasket N. Engl. J. Med., September 5, 2002; 347(10): 769 - 770. [Full Text] [PDF]
|
|
|
|
|
|
T. E. Mayer, G. F. Hamann, and H. J. Brueckmann Treatment of Basilar Artery Embolism With a Mechanical Extraction Device: Necessity of Flow Reversal Stroke, September 1, 2002; 33(9): 2232 - 2235. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Eckert, C. Koch, G. Thomalla, J. Roether, and H. Zeumer Acute Basilar Artery Occlusion Treated With Combined Intravenous Abciximab and Intra-arterial Tissue Plasminogen Activator: Report of 3 Cases Stroke, May 1, 2002; 33(5): 1424 - 1427. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. T. Cross III, C. P. Derdeyn, and C. J. Moran Bleeding Complications after Basilar Artery Fibrinolysis with Tissue Plasminogen Activator AJNR Am. J. Neuroradiol., March 1, 2001; 22(3): 521 - 525. [Abstract] [Full Text]
|
|
|
|
|
|
T. Brott and J. Bogousslavsky Treatment of Acute Ischemic Stroke N. Engl. J. Med., September 7, 2000; 343(10): 710 - 722. [Full Text] [PDF]
|
|
|
|
|
|
R. T. Higashida, L. N. Hopkins, A. Berenstein, V. V. Halbach, and C. Kerber* Program Requirements for Residency/Fellowship Education in Neuroendovascular Surgery/Interventional Neuroradiology: A Special Report on Graduate Medical Education AJNR Am. J. Neuroradiol., June 1, 2000; 21(6): 1153 - 1159. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. Grond, J. Rudolf, S. Schmulling, C. Stenzel, M. Neveling, and W.-D. Heiss Early Intravenous Thrombolysis With Recombinant Tissue-type Plasminogen Activator in Vertebrobasilar Ischemic Stroke Arch Neurol, April 1, 1998; 55(4): 466 - 469. [Abstract] [Full Text] [PDF]
|
|