THROMBOLYSIS IN THE VERTEBROBASILAR CIRCULATION - THE AUSTRALIAN UROKINASE STROKE TRIAL - A PILOT-STUDY

Stroke due to basilar artery occlusion has a high mortality and morbid ity. Intra-arterial thrombolysis has been reported to improve survival and outcome status. Our aim was to assess the safety and efficacy of intra-arterial urokinase in a consecutive series of patients with clin ically severe brainstem ischaemic stroke and major vertebrobasilar ves sel occlusion. Incremental doses of urokinase were administered until clot lysis was achieved, or until a limit of 1,000,000 U. Patients wer e then anticoagulated with heparin and warfarin, and 6-month functiona l status was measured by the Barthel index. Sixteen patients, aged 22- 73 (median 60), were treated 5-31 (median 15) h following symptom onse t. Thirteen of the 16 patients (82%) had initial complete or partial r ecanalisation. Complete occlusion of the basilar artery was present in 13, and recanalisation was achieved in 10 of these (77%), although 2 re-occluded. Four of 5 patients with persistent occlusion died, compar ed with only 1 death in 8 patients with sustained recanalisation (p = 0.02, Fisher's exact test, one-tailed). Intra-arterial urokinase can r ecanalise basilar artery occlusion, with significant reduction in mort ality at 6 months. A prospective randomised, controlled trial is neces sary to confirm the benefit of this therapy.