THROMBOLYTIC THERAPY OF ACUTE BASILAR ARTERY-OCCLUSION - VARIABLES AFFECTING RECANALIZATION AND OUTCOME

Background and Purpose Thrombolysis may reduce mortality after acute b asilar artery (BA) occlusion. We intended to find variables affecting recanalization and clinical outcome in patients with BA occlusion unde rgoing thrombolytic therapy. Methods We analyzed in retrospect the cli nical and angiographic data of a consecutive series of 51 patients tre ated with intra-arterial urokinase (n = 44; 0.3 to 1.5 mIU) or intrave nous or intra-arterial recombinant tissue plasminogen activator (n = 7 ; 22 to 100 mg). We identified effective variables by multiple logisti c regression analyses and univariate tests. Results Sites of occlusion were the caudal (n = 23), middle (n = 18), and distal (n = 10) segmen ts of the BA. The pathogenesis was embolism in 35 and local atherothro mbosis in 16 patients. Collateral circulation was good in 32 patients and poor or absent in 19 patients. Recanalization was achieved in 26 o f 51 (51%) patients and was associated with occlusions of embolic etio logy (P = .0025). Mortality was 46% (12/26)in the recanalization group and 92% (23/25) in the nonrecanalization group (P = .0004). Other ind ependent variables affecting mortality were length of BA obstruction ( P = .0011), age (P = .0008), and collateral state (P = .0454). After f ollow-up (median, 32 months), 10 of the 16 survivors were only minimal ly impaired, with a Barthel Index score of 95 or greater; 5 patients w ere moderately and 1 severely disabled. Conclusions Recanalization of acute BA occlusion reduces mortality significantly. Length of BA obstr uction and state of the collaterals are additional independent variabl es affecting survival. Young patients with monosegmental embolic occlu sion of the BA seem to have the best chance to considerably profit fro m thrombolysis.