Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty.
BACKGROUND
Vertebrobasilar artery occlusion (VBO) produces high mortality and morbidity due to low recanalization rate utilization in endovascular therapy. The use of percutaneous transluminal angioplasty (PTA) to improve recanalization rate additional to local intra-arterial fibrinolysis (LIF) was investigated in this study. Results obtained following recanalization therapy in acute intracranial VBO are reported.


METHODS
Eighteen consecutive patients with acute VBO underwent LIF with or without PTA, from August 2000 to May 2006. Eight patients were treated using LIF alone, and ten required additional PTA. Rate of recanalization, neurological status before treatment, and clinical outcomes were evaluated.


RESULTS
Of 18 patients, 17 achieved recanalization. One procedure-related complication of subarachnoid hemorrhage occurred. Overall survival rate was 94.4% at discharge. Seven patients achieved good outcomes [modified Rankin scale (mRS) 0-2], and the other 11 had poor outcomes (mRS 3-6). Five of six patients who scored 9-14 on the Glasgow Coma Scale (GCS) before treatment displayed good outcomes, whereas ten of 12 patients who scored 3-8 on the GCS showed poor outcomes. GCS prior to treatment showed a statistically significant correlation to outcomes (p < 0.05). Moreover, the National Institutes of Health Stroke Scale (NIHSS) before treatment correlated well with mRS (correlation coefficient 0.487). No statistical difference between the good and poor outcome groups was observed for the duration of symptoms, age, etiology, and occlusion site.


CONCLUSIONS
Endovascular recanalization can reduce mortality and morbidity of acute VBO. Good GCS and NIHSS scores prior to treatment can predict the efficacy of endovascular recanalization.
Kashiwagi
Junji
J
Department of Radiology, Shinbeppu Hospital, 874-0833, Tsurumi 3898, Beppu, Oita, Japan. jaykay@med.oita-u.ac.jp
Kiyosue
Hiro
H
Hori
Yuzo
Y
Okahara
Mika
M
Tanoue
Shuichi
S
Sagara
Yoshiko
Y
Abe
Toshi
T
Mori
Hiromu
H
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000628:therapy*; D001488:Basilar Artery; D001921:Brain / Q000098:blood supply / Q000187:drug effects / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy / Q000628:therapy*