Fibrinolytic Therapy in Acute Vertebrobasilar Stroke

Abstract

Local intra-arterial administration of fibrinolytic agents has been successfully used to achieve recanalization in acute thrombotic stroke patients (Zeumer, H., J Neurol 231:287-294, 1985).65 consecutive patients with clinical signs of severe brainstem ischemia and angiographically demonstrated vertebrobasilar (VB) thrombotic occlusion were treated with antithrombotic therapy.22 patients (Group A) received antiplatelet/anticoagulant treatment. 43 patients (Group B) received local intra-arterial infusion of streptokinase or urokinase proximal to the thrombotic occlusion. In 19 patients of Group B (Group B1) arterial recanalization was achieved as demonstrated angiographically; in 24 patients (Group B2) the arterial occlusion could not be resolved. None of the patients in Group B2 survived.When clinically favorable (minimal/moderate deficit) and unfavorable (severe deficit/demise) outcomes are compared, the results are highly significant (B1 vs A; p <0.007; B1 vs B2; p <0.0003 .It was possible to describe the vascular conditions associated with angiographically unsuccessful fibrinolytic therapy (Group B2) and to identify the clinical conditions associated with an unfavorable clinical outcome in patients with successful lysis (Group B1). These data indicate that successful fibrinolytic therapy is associated with a beneficial clinical effect in VB thrombotic stroke.