Bleeding complications after basilar artery fibrinolysis with tissue plasminogen activator.
OBJECTIVE
Fibrinolysis with local intraarterial urokinase infusion for basilar artery thrombosis has been associated with a low rate of spontaneous symptomatic cerebral hemorrhage, even when patients have been treated late in the course of symptoms. Because urokinase is presently unavailable in the United States, this study was undertaken to determine the frequency of spontaneous cerebral hemorrhage in basilar artery fibrinolysis performed with tissue plasminogen activator (tPA).


METHODS
In a retrospective review of our initial experience with cerebral fibrinolysis for acute stroke using intraarterial tPA, four cases of basilar thrombosis were identified. Doses of the fibrinolytic agent and heparin, angiographic findings, clinical courses, and bleeding complications for these patients were determined. These results were compared with those from a prior study of 20 similar consecutive patients treated with urokinase.


RESULTS
Symptom duration before treatment was unlimited. Intraarterial doses of tPA were 20 to 50 mg. Patients received full systemic anticoagulation with heparin. Complete basilar artery recanalization was achieved in 75% of patients. Two patients treated with tPA had angioplasty and stent placement for related high-grade stenosis. Spontaneous symptomatic cerebral hemorrhage occurred in three (75%) of the four tPA-treated patients and in three (15%) of the 20 urokinase-treated patients.


CONCLUSIONS
The cerebral hemorrhage complication rate for intraarterial fibrinolysis with tPA was very high in cases of basilar artery thrombosis at the doses we used. Protocol adjustments should be considered.
Department of Radiology, Box 8131, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA.
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Moran
D000328:Adult; D000368:Aged; D001488:Basilar Artery / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007269:Injections, Intra-Arterial; D020767:Intracranial Thrombosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator