Local Thrombolytic Therapy in Acute Basilar Artery Occlusion: Experience with 18 Patients
Since the introduction of local thrombolytic therapy (LTT) in acute ischemia by Zeumer and colleagues in 1982 , it has been possible to rescue patients with basilar artery occlusion and progressive brain stem damage and to limit their neurological deficiencies [1, 2]. We have treated 18 patients with local intraarterial lysis who suffered from basilar artery occlusions at various sites (Fig. 1). LTT was used because the following prerequisites were fulfilled. Clinically the patients presented with progressive strokes in the vertebrobasilar territory. Digital subtraction angiography showed either an occlusion of the basilar artery or of both intracranial vertebral arteries and there were no contraindications of LTT, such as sustained coma or coma with lack of brain stem reflexes or major brain stem lesions. A microcatheter was positioned close to the occlusion, whenever possible, between the thrombus and arterial wall. Then fibrinolysis was instituted with continuous administration of streptokinase or urokinase through a perfusion system. The given range was 120000–600000 U streptokinase or 300000–950000 U urokinase within 2h. Angiographic checks were made every ½. If then sufficient recanalization had been achieved, treatment was stopped and intravenous anticoagulation with heparin was started. If no reopening resulted within 2h, the lysis therapy was terminated.
KeywordsCatheter Ischemia Heparin Streptokinase Hemiplegia
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