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(Stroke. 2002;33:1424.)
© 2002 American Heart Association, Inc.

Case Reports

Acute Basilar Artery Occlusion Treated With Combined Intravenous Abciximab and Intra-arterial Tissue Plasminogen Activator

Report of 3 Cases

Bernd Eckert, MD; Christoph Koch, MD; Götz Thomalla, MD; Joachim Roether, MD Herrmann Zeumer, MD

From the Departments of Neuroradiology (B.E., C.K., H.Z.) and Neurology (G.T., J.R.), University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Correspondence to Dr Bernd Eckert, Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. E-mail b.eckert{at}uke.uni-hamburg.de

Abstract

Background— Acute vertebrobasilar occlusion remains a disease with a high mortality even after treatment by local intra-arterial fibrinolysis. Adjunctive treatment with platelet glycoprotein IIb/IIIa receptor inhibitors such as abciximab may facilitate recanalization and improve the neurological outcome. Results after treatment of 3 patients by combined intravenous abciximab and local intra-arterial tissue plasminogen activator (tPA) are reported.

Case Descriptions— Treatment was performed within 6 hours of stroke onset. Angiography revealed embolic occlusion of the basilar artery in 2 patients and atherothrombotic occlusion at the vertebrobasilar junction in 1 patient. Therapy consisted of intravenous abciximab bolus administration (0.25 mg/kg) followed by 12-hour infusion therapy (0.125 µg/kg per minute) and local intra-arterial thrombolysis with tPA (10 mg/h). Heparin was only applied for catheter flushing (500 IU/h). The patient with the atherothrombotic occlusion was treated with additional percutaneous transluminal angioplasty and stenting. Complete recanalization of the basilar artery occurred in 2 patients, whose conditions improved clinically to functional independence. In the third patient only partial recanalization was seen, with only slight clinical improvement. This patient died of cardiac failure 2 months later. Besides a subtle subarachnoid hemorrhage (n=1), no intracranial or extracranial bleeding complication was observed.

Conclusions— The combination of glycoprotein IIb/IIIa receptor inhibitor with local intra-arterial tPA might be a promising therapy for patients with acute vertebrobasilar occlusion. Further studies are necessary to define the clinical benefit and the bleeding rate of this new pharmacological approach.

Key Words: antibodies, monoclonal • basilar artery • fibrinolysis • stroke, ischemic • thrombolytic therapy • vertebral artery

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