Retrospective analysis of neurological outcome after intra-arterial thrombolysis in basilar artery occlusion.
BACKGROUND
Basilar artery occlusion usually has a very poor outcome and is associated with a high mortality rate. Local intra-arterial thrombolysis may improve the clinical outcome and reduce mortality in the treatment of acute basilar artery occlusion. We evaluated the possible variables affecting recanalization and clinical outcome in patients with basilar artery occlusions undergoing thrombolytic therapy.


METHODS
We analyzed retrospectively the clinical course and outcome of a series of 26 patients between 1998 and 2001. All patients who were examined within 24 hours after onset of symptoms underwent emergency cerebral angiography and subsequent intra-arterial thrombolysis. Three patients additionally received percutaneous transluminal angioplasty of underlying stenosis at the site of thrombosis.


RESULTS
Outcome was good in 9 patients (34.6%) and poor in 17 (65.4%). Recanalization could be achieved in 24 patients (92.3%) and was not affected by age, sex, site of occlusion, etiology, thrombolytic drugs, or time interval. Good outcome was associated with younger age, good initial clinical condition, and no evidence of brain stem infarction. There was no association between the interval (greater or less than 6 hours) from the onset of symptoms until the end of thrombolysis and survival.


CONCLUSIONS
We confirm that intra-arterial thrombolysis reduces mortality in basilar artery occlusion. Young patients (<75 years) without any infarct in brain stem before the start of treatment seem to be the ideal candidates for thrombolysis. Basilar artery thrombosis could and should be reopened, even late (after 6 hours) after symptom onset.
Department of Neurosurgery, Sankokai Miyazaki Hospital, Nagasaki City, Japan.
Yasuyuki
Y
Ezaki
Keisuke
K
Tsutsumi
Masanari
M
Onizuka
Junichi
J
Kawakubo
Nobuhiro
N
Yagi
Akira
A
Shibayama
Tamotsu
T
Toba
Hiroaki
H
Koga
Hisaya
H
Miyazaki
D000208:Acute Disease; D000368:Aged; D001488:Basilar Artery; D002544:Cerebral Infarction / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D020767:Intracranial Thrombosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome