Local intraarterial thrombolysis in vertebrobasilar thromboembolic disease

The poor prognosis of basilar artery occlusion is well known. Systemic anticoagulation rarely prevents a lethal outcome. A new therapeutic approach involves selective perfusion of strep-tokinase through the vertebrobasilar artery via a coaxial catheter system. Three of five reported cases demonstrated successful vascular recanalization with clinical improvement. Between 1976 and 1981, 17 patients with angiog raphically di-agnosed basilar artery thrombosis were treated at our c linic. Ten patients d ied within 2 weeks, while six patients su rvived more than 6 weeks but less than 3 months. Only one pat ient survived a 1 year period. All the patients had severe neurologic deficits and died from secondary complications such as pulmonary thromboembolism, myocardial infarc tion, or pneumonia. These results parallel th e experiences of others [1-4] in documenting the poor prognosis of basi lar artery thrombosis. In our view, the standard reg imen using heparin and other anticoagu lants offered no proven therapeutic advantage. With this in mind, we fe lt challenged to develop a new therapy, despite the possible dangers involved. The system ic administrat ion of the fibrinolytic agent streptoki-nase in doses of 2,500,000 IU / day is reported to be hazardous and fraught with complicat ions [5]. Moreover, this therapy cannot be applied soon after angiog raphy because of the certainty of local bleeding. However, card iologists [6-8] have demonstrated that in pat ients wi th coronary artery thrombosis, th e local use of fibrinolyti c agents is superior to system ic applicat ion and that even in high local concentrat ions, the systemic effect is minimal. Our approach involved selecti ve perfusion of streptok inase through the vertebro-basi lar artery by means of a coaxial catheter system. Results of the treatment if") five cases are reported. Methods The technique used to perform local fibrinolysis in the vertebro-basilar system is relatively simple: A 6 French Torcon cathete