Acute vertebrobasilar occlusion: current treatment strategies.
Acute vertebrobasilar occlusion (VBO) remains a disease with a high mortality. Local intraarterial fibrinolysis (LIF) can reduce the mortality rate from about 90 to 60%. The combined therapy of i.v. Abciximab and i.a. rt-PA with additional PTA/stenting may improve neurological outcome and significantly reduce mortality, despite an increase of overall bleeding complications. Additional PTA/stenting is an important treatment factor in cases of atherothrombotic occlusion. In embolic occlusions, mechanical catheter devices, such as basket or snare devices or rheolytic systems, are promising therapies for the near future. This article describes diagnostic criteria and treatment factors in acute VBO. Different treatment strategies, such as i.v. and i.a. fibrinolysis, adjunctive application of GP IIb/IIIa inhibitors, PTA/stenting and mechanical embolectomy are addressed in detail.
Eckert
Bernd
B
Allgemeines Krankenhaus Altona, Funktionsbereich Neuroradiologie, Hamburg, Germany. bernd.eckert@ak-altona.lbk-hh.de
D000077284:Abciximab; D000800:Angioplasty, Balloon; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents; D014715:Vertebrobasilar Insufficiency / Q000401:mortality / Q000601:surgery / Q000628:therapy*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab