Abstract
Eleven cases with acute occlusion of vertebrobasilar artery were treated by local fibrinolysis (LF). Ten were male and one was female, ranging in age from 46 to 85 years. The occlusive site was the basilar artery in 10 cases and bilateral vertebral arteries in one. Glasgow Coma Scale before treatment was 13 or more in 3 cases, from 8 to 12 in 2 cases, and 4 in 6 cases. Collateral circulation via a posterior communicating artery was good in 1, fair in 3, and poor in 6, and unknown in 1. LF was performed by the superselective technique using a microcatheter. The thrombolytic agent used was urokinase in 3 cases and tissue plasminogen activator in 8. Angiographic results: Successful recanalization was achieved in all cases, with residual stenosis of 50% or less in 8 cases, and with severe stenosis in 2. The time delay from the onset to recanalization was from 1.5 to 17 hours. The recanalized artery occluded again in 2 cases after 3 weeks and 7 weeks, respectively. Clinical result: Clinical symptoms improved immediately after treatment in 6 of 11 cases. Two of these 6 died in the follow-up period because of reocclusion. The other 5 cases developed a severe brain stem infarction resulting in death. Glasgow Outcome Scale was GR in 3 cases, MD in 1, and D in 7.
It is concluded that LF is a potential therapy for acute vertebrobasilar arterial occlusion. Clinical improvement will be achieved in patients with a good collateral circulation via a posterior communicating artery. Some revascularizing technique for the residual stenotic lesions after LF therapy may improve the clinical outcome.
