Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke.
BACKGROUND
Patients with ischaemic stroke due to occlusion of the basilar or vertebral arteries may develop a rapid deterioration in neurological status leading to coma and often to death. While intra-arterial thrombolysis may be used in this context, no randomised controlled data exist to support its safety or efficacy.


METHODS
Randomised controlled trial of intra-arterial urokinase within 24 h of symptom onset in patients with stroke and angiographic evidence of posterior circulation vascular occlusion.


RESULTS
Sixteen patients were randomised, and there was some imbalance between groups, with more severe strokes occurring in the treatment arm. A good outcome was observed in 4 of 8 patients who received intra-arterial urokinase compared with 1 of 8 patients in the control group.


CONCLUSIONS
These results support the need for a large-scale study to establish the efficacy of intra-arterial thrombolysis for acute basilar artery occlusion.
Macleod
M R
MR
National Stroke Research Institute, Melbourne, Australia. malcolm@apoptosis.freeserve.co.uk
Davis
S M
SM
Mitchell
P J
PJ
Gerraty
R P
RP
Fitt
G
G
Hankey
G J
GJ
Stewart-Wynne
E G
EG
Rosen
D
D
McNeil
J J
JJ
Bladin
C F
CF
Chambers
B R
BR
Herkes
G K
GK
Young
D
D
Donnan
G A
GA
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000188:drug therapy*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy*; D017741:Survivors; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy
D000925:Anticoagulants; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator