Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease.

TLDR

We retrospectively studied 65 patients with vertebrobasilar occlusion, comparing 43 who received intra‑arterial thrombolytics (urokinase or streptokinase) to 22 who received conventional antiplatelet/anticoagulant therapy, and evaluated occlusion patterns, recanalization, and clinical outcomes. Recanalization achieved in 19 of 43 thrombolysis patients was strongly associated with survival and favorable outcomes, whereas all 24 non‑recanalized patients died and only 3 of 22 conventional‑therapy patients survived, underscoring the benefit of successful thrombolysis.

Abstract

In this retrospective analysis we report our treatment experience in 65 consecutive patients with clinical signs of severe brainstem ischemia with angiographically demonstrated thrombotic vertebrobasilar artery occlusions who received either local intra-arterial thrombolytic therapy (urokinase or streptokinase) (43 patients) or conventional therapy (antiplatelet agents or anticoagulants) (22 patients). We analyzed the data with respect to cerebral artery occlusion patterns, posttreatment arterial recanalization, and the clinical categories of favorable/unfavorable outcome and survival/death. In subgroup analyses, recanalization in patients who received thrombolytic therapy correlated significantly with clinical outcome; in 19 of 43 patients, recanalization was demonstrated angiographically, while in 24 patients the occlusion persisted. All patients without recanalization died, but 14 of the 19 patients displaying recanalization survived (p = 0.000007), 10 with a favorable clinical outcome. Only three of the 22 patients who received conventional therapy survived, all with a moderate clinical deficit. When we compared the treatment groups, highly significant differences in both outcome quality (p = 0.017) and survival (p = 0.0005) were found to depend on establishing recanalization. Our data support the concept that technically successful thrombolysis of vertebrobasilar artery occlusions is associated with beneficial clinical outcome.