Thrombolytic therapy in vertebrobasilar occlusion.

Abstract

Since 1983 at the Alfred Hospital 4 patients with thrombotic or embolic vertebrobasilar occlusions have been treated with intra-arterial streptokinase (SK) infusions for the effects of persisting brainstem ischaemia despite anticoagulation with heparin. In 3 cases there was immediate and dramatic neurological improvement, in all cases associated with arteriographically demonstrated reperfusion of a blocked vessel. Two of these patients suffered further thromboembolic vertebral or basilar artery occlusions (3 days and 2 years later) but recovered fully without further thrombolytic therapy. The other patient was given intra-arterial SK 12 days after an apparently completed brainstem stroke: the therapy failed to cause reperfusion of a vertebral occlusion or produce any clinical improvement. Complications from the therapy were nausea requiring the termination of the SK infusion in one case, easily controlled bleeding from a recent surgical wound, and a clinically insignificant haemorrhagic transformation of cerebellar infarction in a third. The benefits of thrombolytic therapy in vertebrobasilar ischaemia and the dose of streptokinase required are discussed.

• Authors: D Thyagarajan, R J Stark, J Frayne, B S Gilligan, N Sacharias
• Journal: Clinical and experimental neurology (Clin Exp Neurol) Vol. 29 Pg. 129-42 ( 1992) ISSN: 0196-6383 [Print] Australia
• PMID: 1343857 (Publication Type: Case Reports, Journal Article)

Chemical References

• Streptokinase

Topics

• Cerebral Angiography
• Female
• Humans
• Injections, Intra-Arterial
• Male
• Middle Aged
• Streptokinase (therapeutic use)
• Thrombolytic Therapy (adverse effects)
• Tomography, X-Ray Computed
• Vertebrobasilar Insufficiency (diagnostic imaging, therapy)