Stroke, Vol 19, 1216-1222, Copyright © 1988 by American Heart Association
W Hacke, H Zeumer, A Ferbert, H Bruckmann and GJ del Zoppo
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.
ARTICLES
Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease
Department of Neurology, Klinikum Rheinisch-Westfahlische Technische Hochschule, Aachen, Federal Republic of Germany.
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