Long-term outcome after local intra-arterial fibrinolysis of basilar artery thrombosis

Cerebrovasc Dis. May-Jun 2000;10(3):183-8. doi: 10.1159/000016054.

Abstract

Thrombolytic therapy of acute basilar artery (BA) thrombosis has been shown to reduce mortality and avoid a fatal outcome. Objective of this study was to investigate the long-term clinical outcome following intra-arterial fibrinolysis of occlusions of the BA. We retrospectively analyzed the clinical records and neuroradiologic results of 20 consecutive patients who had intra-arterial fibrinolysis of acute occlusions of the BA between 1982 and 1990. All patients were followed neurologically for a period of up to 12 years, including assessment of the Barthel index (BI) and brain CT or MRI studies. At the time of treatment, 6 patients were somnolent and 14 comatose, and tetraparesis was present in 15. The time between the onset of symptoms and treatment ranged from 1 to 48 h. The mortality rate was 35% (7/20 patients). Functional outcome was excellent in 9, 78%, of 13 survivors (BI <85). During the cumulative follow-up period (125 patient years) there was 1 death from myocardial infarction and 1 death from pneumonia. Vascular events during follow-up were myocardial infarction (n = 3) and a single cerebral transient ischemic attack. Despite the fact that our series was biased towards patients with severe symptoms, 65% (13/20) survived, and 78% of the survivors reached independence in daily life. These results provide evidence that local fibrinolysis of BA occlusion reduces mortality, and the long-term prognosis of the survivors is better than previously thought. None of our patients had a further stroke during the follow-up period, which indicates that acute BA occlusion is not a strong indicator for advanced arteriosclerotic disease.

MeSH terms

  • Adult
  • Aged
  • Basilar Artery* / diagnostic imaging
  • Cerebral Angiography
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use*
  • Follow-Up Studies
  • Humans
  • Infusions, Intra-Arterial
  • Intracranial Thrombosis / diagnosis
  • Intracranial Thrombosis / drug therapy*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies
  • Time Factors
  • Tomography, X-Ray Computed

Substances

  • Fibrinolytic Agents