THROMBOLYTIC THERAPY IN ACUTE OCCLUSION OF THE INTRACRANIAL INTERNAL CAROTID-ARTERY BIFURCATION

PURPOSE: To evaluate efficacy and clinical benefit of early thrombolyt ic therapy in intracranial internal carotid artery occlusion. METHODS: Thirty-two patients (mean age, 56 years) with acute intracranial inte rnal carotid artery occlusion were studied clinically and with CT and angiography before and after thrombolytic therapy with intravenous alt eplase (n = 16), superselective intraarterial alteplase (n = 8), and s uperselective intraarterial urokinase (n = 8). RESULTS: Initial CT sho wed a large parenchymal hypodensity in 11 (34%) patients, a small hypo density in 15 (47%) patients, and no hypodensity in 6 (19%) patients. Recanalization after thrombolytic therapy was observed in 4 patients ( 12.5% in each treatment group). Follow-up CT showed six hemorrhagic in farcts and four parenchymal hematomas unrelated to recanalization, alt eplase, or urokinase administration, but commonly associated with intr aarterial treatment. Clinical outcome was fatal in 53%, poor in 31%, a nd moderate or good in 16% of the patients. Outcome was equal in diffe rent treatment groups and closely linked to both the quality of leptom eningeal collaterals and the extent of parenchymal hypodensity on the first CT. CONCLUSION: Because intravenous or intraarterial treatment w ith alteplase or urokinase fails to recanalize the vascular obstructio n, it does not improve the prognosis of intracranial internal carotid artery occlusion over that of the natural course. Improved results may be possible with novel recanalization techniques.