FIBRINOLYTIC THERAPY IN ACUTE VERTEBROBASILAR STROKE

Local intra-arterial administration of fibrinolytic agents has been successfully used to achieve recanalization in acute thrombotic stroke patients (Zeumer, H., J Neurol 231:287-294, 1985).65 consecutive patients with clinical signs of severe brainstem ischemia and angiographically demonstrated vertebrobasilar (VB) thrombotic occlusion were treated with antithrombotic therapy.

22 patients (Group A) received antiplatelet/anticoagulant treatment. 43 patients (Group B) received local intra-arterial infusion of streptokinase or urokinase proximal to the thrombotic occlusion. In 19 patients of Group B (Group B₁) arterial recanalization was achieved as demonstrated angiographically; in 24 patients (Group B₂) the arterial occlusion could not be resolved. None of the patients in Group B₂ survived.

When clinically favorable (minimal/moderate deficit) and unfavorable (severe deficit/demise) outcomes are compared, the results are highly significant (B₁ vs A; p <0.007; B₁ vs B₂; p <0.0003 .

It was possible to describe the vascular conditions associated with angiographically unsuccessful fibrinolytic therapy (Group B₂) and to identify the clinical conditions associated with an unfavorable clinical outcome in patients with successful lysis (Group B₁). These data indicate that successful fibrinolytic therapy is associated with a beneficial clinical effect in VB thrombotic stroke.