Successful treatment of an acute thrombosis of an intracranial vertebral artery endarterectomy with urokinase.
This is a case report of a 47-year-old man admitted with a 7-month history of disequilibrium, multiple reversible vertebrobasilar ischemic attacks, and one submaximal completed stroke in the left posterior inferior cerebellar artery distribution. Vertebrobasilar ischemic attacks continued despite anti-coagulation, and orthostatic symptomatology suggested a significant hemodynamic component contributing to the posterior circulation ischemia. Angiography confirmed bilateral high-grade stenoses of the intracranial vertebral arteries. A right intracranial vertebral artery endarterectomy was performed with electroencephalographic and somatosensory evoked potential monitoring and protection with barbiturate infusion. The arteriotomy was closed with a vein patch. Postoperatively, the endarterectomy site thrombosed. This thrombosis was completely reversed with 220,000 U of urokinase selectively infused intra-arterially at the site of thrombosis. This procedure was not complicated by hemorrhage or distal embolization. The vertebral artery was confirmed to be patent 24 hours and 7 days after the urokinase injection. The patient sustained a borderzone infarction in the right cerebellar hemisphere without neurological deficits and was discharged home well.
Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia.
M K
MK
Morgan
V
V
Grinnell
N S
NS
Little
M J
MJ
Day
D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography / Q000187:drug effects; D004691:Endarterectomy; D006083:Graft Occlusion, Vascular / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*
D014568:Urokinase-Type Plasminogen Activator