Long-term outcome after local intra-arterial fibrinolysis of basilar artery thrombosis.
Thrombolytic therapy of acute basilar artery (BA) thrombosis has been shown to reduce mortality and avoid a fatal outcome. Objective of this study was to investigate the long-term clinical outcome following intra-arterial fibrinolysis of occlusions of the BA. We retrospectively analyzed the clinical records and neuroradiologic results of 20 consecutive patients who had intra-arterial fibrinolysis of acute occlusions of the BA between 1982 and 1990. All patients were followed neurologically for a period of up to 12 years, including assessment of the Barthel index (BI) and brain CT or MRI studies. At the time of treatment, 6 patients were somnolent and 14 comatose, and tetraparesis was present in 15. The time between the onset of symptoms and treatment ranged from 1 to 48 h. The mortality rate was 35% (7/20 patients). Functional outcome was excellent in 9, 78%, of 13 survivors (BI <85). During the cumulative follow-up period (125 patient years) there was 1 death from myocardial infarction and 1 death from pneumonia. Vascular events during follow-up were myocardial infarction (n = 3) and a single cerebral transient ischemic attack. Despite the fact that our series was biased towards patients with severe symptoms, 65% (13/20) survived, and 78% of the survivors reached independence in daily life. These results provide evidence that local fibrinolysis of BA occlusion reduces mortality, and the long-term prognosis of the survivors is better than previously thought. None of our patients had a further stroke during the follow-up period, which indicates that acute BA occlusion is not a strong indicator for advanced arteriosclerotic disease.
Berg-Dammer
E
E
Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany.
Felber
S R
SR
Henkes
H
H
Nahser
H C
HC
Kühne
D
D
D000328:Adult; D000368:Aged; D001488:Basilar Artery / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents