Local Intra-arterial Fibrinolysis in the Vertebrobasilar and Carotid Territories

  • Hermann Zeumer
  • F. Zanella
Part of the Medical Radiology book series (MEDRAD)

Abstract

Thromboembolic occlusion of the large pial vessels is a major cause of cerebral ischemic stroke. Recanalization of such occluded vessels seems to be the most reasonable therapeutic strategy in stroke patients. However, after the introduction of streptokinase as an effective fibrinolytic agent in the 1960s, early trials to ascertain its efficacy in stroke-prone patients failed to demonstrate a reasonable benefit to risk ratio (Del Zoppo et al. 1986). On the other hand, local fibrinolysis with the aim of coronary artery re-canalization proved effective in providing high recanalization rates with less systemic hemorrhagic effects. In the cerebral arteries local intra-arterial fibrinolytic (LIF) therapy has been applied primarily in those patients commonly displaying progression of stroke, usually with a lethal outcome, e.g., patients with acute vertebrobasilar occlusion (AVBO). The prognosis of patients suffering from AVBO was shown by Hacke et al. (1988) to be improved significantly using this treatment.

Keywords

Catheter Ischemia Urea Heparin Neurol 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams HP, Damasio HC, Putman SF, Damasio AR (1983) Middle cerebral artery occlusion as a cause of isolated subcortical infarction. Stroke 14:948–951PubMedCrossRefGoogle Scholar
  2. Archer CR, Horenstein S (1977) Basilar artery occlusion. Clinical and radiological correlation. Stroke 8:383–390PubMedCrossRefGoogle Scholar
  3. Astrup J, Siesjö B, Symon L (1981) Thresholds in cerebral ischemia: the ischemic penumbra. Stroke 12:723–725PubMedCrossRefGoogle Scholar
  4. Bladin PF, Berkovic SF (1984) Striatocapsular infarction: large infarcts in the lenticulostriate arterial territory. Neurology 34:1423–1430PubMedGoogle Scholar
  5. Brückmann H, Ferbert A, del Zoppo GJ, Hacke W, Zeumer H (1986) The acute vertebral-basilar thrombosis. Angiological-clinical comparison and therapeutic implications. Acta Radiol [Suppl] 369:38–42Google Scholar
  6. Caplan LR (1980) “Top of the basilar artery” syndrome. Neurology 30:72–79PubMedGoogle Scholar
  7. Caplan LR (1983) Bilateral distal vertebral artery occlusion. Neurology 33:552–558PubMedGoogle Scholar
  8. del Zoppo GJ, Zeumer H, Harker LA (1986) Thrombolytic therapy in stroke. Possibilities and hazards. Stroke 17:595–607PubMedCrossRefGoogle Scholar
  9. del Zoppo GJ, Ferbert A, Otis S et al. (1987) Local intraarterial fibrinolytic therapy in acute carotid territory stroke. Stroke 19:307–313CrossRefGoogle Scholar
  10. Ferbert A, Brückmann H, Drummen R (1990) Clinical features of proven basilar artery occlusion. Stroke 21:1135–1142PubMedCrossRefGoogle Scholar
  11. Fieschi C, Bozzao L (1969) Transient embolic occlusion of the middle cerebral and internal carotid arteries in cerebral apoplexy. J Neurol Neurosurg Psychiatry 32:236–240PubMedCrossRefGoogle Scholar
  12. Fisher CM (1988) The “Herald hemiparesis” of basilar artery occlusion. Arch Neurol 45:1301–1303PubMedCrossRefGoogle Scholar
  13. Gelmers HJ, Hennerici M (1990) Effect of nimodipine on acute ischemic stroke. Pooled results from five randomized trials. Stroke 21:81–84Google Scholar
  14. Hacke W, Hirschberg M (1990) Thrombolytic therapy in acute ischemic stroke — an update. Stroke Int 1:17–19Google Scholar
  15. Hacke W, del Zoppo GJ, Harker LA (1987) Thrombosis and cerebrovascular disease. In: Poeck K, Ringelstein EB, Hacke W (eds) New trends in diagnosis and management of stroke. Springer, Berlin Heidelberg New York, pp 59–74CrossRefGoogle Scholar
  16. Hacke W, Zeumer H, Ferbert A, Brückmann H, del Zoppo GJ (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19:1216–1222PubMedCrossRefGoogle Scholar
  17. Hacke W, del Zoppo GJ, Hirschberg M (1991) Thrombolytic therapy in acute ischemic stroke. Springer, Berlin Heidelberg New YorkCrossRefGoogle Scholar
  18. Hart RG, Easton JD (1986) Hemorrhagic infarcts. Stroke 17:586–589PubMedCrossRefGoogle Scholar
  19. Karnik R, Slany J, Perneczky G, Ammerer HP, Brenner H, Leitner H (1985) Regionale Fibrinolyse akuter Verschlüsse intracerebraler Gefäße. Intensivmedizin 22:31–34Google Scholar
  20. Karnik R, Ammerer HP, Perneczky G, Slany J, Brenner H (1986) Akute Verschlüsse im vertebrobasilären Stromgebiet bei Kindern und jüngeren Erwachsenen. Dtsch Med Wochenschr 111:616–621PubMedCrossRefGoogle Scholar
  21. Kubik CS, Adams RD (1946) Occlusion of the basilar artery — a clinical and pathological study. Brain 69: 73–121PubMedCrossRefGoogle Scholar
  22. Lehmann R, Zschenderlein R, Gromnica-Ihle E, Ziemer S (1989) Lokale intravasale Fibrinolyse (LIF) bei akuten zerebrovaskulären Verschlüssen. Radiol Diagn (Berl) 30:481–488Google Scholar
  23. Möbius E, Berg-Dammer E, Kühne D, Kunitsch G, Nahser HC (1989) Lokale intraarterielle Fibrinolyse: Therapie der Wahl bei A. Basilarisverschluß mit progredientem Hirnstamminfarkt. Aktuelle Neurologie 16:184–190CrossRefGoogle Scholar
  24. Mori E, Tabuchi M, Yoshida T, Yamadori A (1988) Intracarotid urokinase with thromboembolic occlusion of the middle cerebral artery. Stroke 19:802–812PubMedCrossRefGoogle Scholar
  25. Nenci GG, Gresele P, Taramelli M, Agnelli G, Signorini E (1983) Thrombolytic therapy for thromboembolism of vertebrobasilar artery. Angiology 34:561–571PubMedCrossRefGoogle Scholar
  26. Poersch M (1989) Lokale intraarterielle Fibrinolyse. Ergebnisse unterschiedlicher Therapiekonzepte. Inauguraldissertation, Med. Fakultät RWTH AachenGoogle Scholar
  27. Ringelstein EB, Biniek R, Weiller C, Ameling B, Nolte P, Thron A (1991) Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalisation. Neurology 42: 289–298Google Scholar
  28. Schmidt D, Schumacher M, Wakhloo AK (1991) Catheter fibrinolytic therapy with urokinase in central retinal artery occlusion. Am J Ophthalmol (in press)Google Scholar
  29. Schumacher M, Schmidt D (1991) Intraarterial thrombolysis in occlusion of the central retinal artery. Presented at: WIN Meeting, val d’Isere 12.1.91–19.1.91Google Scholar
  30. Seifried E (1988) Klinische und biochemische Zielsetzungen bei der Thrombolysetherapie mit Neothrombolytika speziell mit Gewebeplasminogenaktivator, Prourokin-ase und deren Kombinationen. Hämostaseologie 8:199–213Google Scholar
  31. Siepmann G, Müller-Jensen M, Goossens H, Lachenmayer L, Zeumer H (1991) Local intraarterial fibrinolysis in acute middle cerebral artery occlusion, (in press)Google Scholar
  32. Sturm KW, Zeumer H (1983) Local intraarterial fibrinolysis therapy in the vertebrobasilar system: preliminary post mortem findings. Acta Neurol Scand 68:201Google Scholar
  33. Theron J, Courtheoux P, Casasco A, Alachkar F, Notari F, Ganem F, Maiza D (1989) Local intraarterial fibrinolysis in carotid territory. AJNR 10:753–756PubMedGoogle Scholar
  34. Triggle DJ (1990) Calcium antagonists. History and perspective. Stroke 21:49–58Google Scholar
  35. von Kummer R, Hutschenreuter M, Krieger D, Wildemann B, Wilder-Smith E, Runkehl R, Hacke W (1988) Thrombolyse mit rt-PA bei akuten Verschlüssen intra-kranieller Arterien. Intensivmedizin 25:345Google Scholar
  36. Weiller C, Ringelstein EB, Reiche W, Thron A, Buell U (1990) The large striatocapsular infarct. A clinical and pathophysiological entity. Arch Neurol 47:1085–1091PubMedCrossRefGoogle Scholar
  37. Wise RJS, Bernardi S, Frackowiak RSJ, Legg NJ, Jones T (1983) Serial observations on the pathophysiology of acute stroke. Brain 106:197–222PubMedCrossRefGoogle Scholar
  38. Zeumer H (1985) Vascular recanalising techniques in interventional neuroradiology. J Neurol 231:287–294PubMedCrossRefGoogle Scholar
  39. Zeumer H, Ringelstein EB, Klose FC (1981) Lakunäre Infarkte im Computertomogramm. Differentialdiagnose, klinische und angiographische Befunde. Fortschr Röntgenstr 134:488–494CrossRefGoogle Scholar
  40. Zeumer H, Hacke W, Kolmann HL, Poeck K (1982) Lokale Fibrinolysetherapie bei Basilaristhrombose. Dtsch Med Wochenschr 107:728–731PubMedCrossRefGoogle Scholar
  41. Zeumer H, Hacke W, Ringelstein EB (1983a) Local intraarterial thrombolysis in vertebrobasilar thrombem-bolic disease. AJNR 4:401–404PubMedGoogle Scholar
  42. Zeumer H, Ringelstein EB, Hacke W (1983b) Gefâßre-kanalisierende Verfahren der interventionellen Neuro-radiologie. ROFO 139:467–475PubMedCrossRefGoogle Scholar
  43. Zeumer H, Ringelstein EB, Hassel M, Poeck K (1983c) Lokale Fibrinolysetherapie bei subtotaler Stenose der A. cerebri media. Dtsch Med Wochenschr 108:1103–1105PubMedCrossRefGoogle Scholar
  44. Zeumer H, Hündgen R, Ferbert A, Ringelstein EB (1984) Local intraarterial fibrinolytic therapy in inaccessible internal carotid occlusion. Neuroradiology 26:315–317PubMedGoogle Scholar
  45. Zeumer H, Freitag H-J, Grzyska U, Neunzig H-P (1989) Local intraarterial fibrinolysis in acute vertebrobasilar occlusion. Technical developments and recent results. Neuroradiology 31:336–340PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • Hermann Zeumer
    • 1
  • F. Zanella
    • 1
  1. 1.Abteilung für Neuroradiologie, Radiologische KlinikUniversitätskrankenhaus Eppendorf, Universität HamburgHamburg 20Germany

Personalised recommendations