Intraarterial thrombolysis in vertebrobasilar occlusion

Kyra J. Becker, Lee H. Monsein, John Ulatowski, Marek Mirski, Michael Williams, Daniel F. Hanley

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)255-262
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume17
Issue number2
StatePublished - Mar 8 1996

Keywords

  • Arteries, basilar
  • Arteries, stenosis and occlusion
  • Efficacy studies
  • Thrombolysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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