1997 Volume 19 Issue 4 Pages 318-322
We encountered a case of progressive stroke caused by vertebral artery occlusion and severe basilar artery stenosis. The patient was treated emergently by a combination of local intra-arterial thrombolytic therapy and percutaneous transluminal angioplasty (PTA), with satisfactory results. A 61-year-old man was admitted with consciousness disturbance and tetraparesis. An emergent angiogram revealed occlusion at the V4 portion of the left vertebral artery and the PICA end of the right vertebral artery. Thrombolysis with tissue plasminogen activator was performed, and a slender recanalization was recognized for both the left vertebral artery and basilar artery. PTA was subsequently performed using a balloon catheter, and sufficient dilatation of both stenotic lesions was accomplished at 7.5 hours after onset. The patient was discharged with left hemiparesis. PTA for basilar artery stenosis involves high risk on occlusion of perforating branches. Nevertheless, thrombolytic therapy and PTA for acute progressive stroke would rather be first-choice therapy than medical therapy or bypass surgery.
