Abstract
In the present study, we investigated the clinical efficacy of the local fibrinolytic therapy using microcatheter technique and tissue plasminogen activator (t-PA) in 7 patients with basilar artery embolism. Seven cases were treated in the acute stage, within 6 hours of onset. A microcatheter was introduced into the embolus and/or distal to the embolus to keep high concentration of fibrinolytic agent. The t-PA, 5M units/20 ml, was infused continuously through the microcatheter over 20 minutes, and 5 to 15 M units of t-PA was injected. Complete recanalization of the basilar artery was achieved in 5 of 7 patients from 4 to 7.5 hours after onset. Partial recanalization was achieved in 1 patient and recanalization was not achieved in another patient. Three of 5 patients with complete recanalization recovered fully, but 1 died of cerebellar hemorrhagic infarction and brain stem infarction, and the other died following acute cardiac failure. One patient with partial recanalization became severely disabled and an another patient without recanalization died of cerebellar and brain stem infarction. Local fibrinolytic therapy using microcatheter technique and t-PA was effective in patients with basilar artery embolism with a high recanalization rate. The pretreatment neurological state was correlated with the clinical results. Patients with mild to moderate consciousness disturbance or a fluctuating state of consciousness had good recoveries. However, fixed coma state and/or brain stem dysfunction resulted in poor prognoses even if the complete recanalization was achieved within 6 hours.
