Local intra-arterial fibrinolysis without arterial occlusion?
Local intra-arterial fibrinolysis (LIF) is the best choice at present for treatment of acute vessel occlusion in the vertebrobasilar territory and also, in selected cases, in the carotid territory. In almost all cases angiography demonstrates the site of occlusion exactly and gives information about collateral circulation. Contrary to this common approach, we report five patients with severe acute thromboembolic stroke in whom angiography revealed no occlusion of relevant arteries or their main branches. Under the hypothesis of persisting occlusion of perforating arteries to the brain stem we performed LIF in patients with a clinical basilar artery syndrome. Outcome in all but one of them was good following LIF. The clinical details are described and possible reasons discussed.
Schumacher
M
M
Section of Neuroradiology, University Hospital, Freiburg, Germany.
Yin
L
L
Klisch
J
J
Hetzel
A
A
D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000188:drug therapy*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator