VERTEBROBASILAR THROMBOSIS - DIAGNOSIS, MANAGEMENT, AND THE USE OF INTRAARTERIAL THROMBOLYTICS

Objectives: To review the diagnosis and management of vertebrobasilar thrombosis and to discuss the use of thrombolytics in the treatment of this disease. Data Sources: Selected references discussing epidemiolo gy, anatomy, pathophysiology, diagnosis, therapy, and rehabilitation o f vertebrobasilar occlusive disease. Study Selection: Studies addressi ng acute intervention and outcome in the therapy of vertebrobasilar th rombosis were reviewed. Data Extraction: Only those studies with angio graphic documentation of arterial thrombosis and, in the case of throm bolysis, recanalization, were considered valid. Data Synthesis: Thromb osis of the vertebrobasilar system is a highly fatal disease and shoul d be treated as a neurologic emergency, The key to effective managemen t depends on early recognition of the symptom complex and a thorough u nderstanding of the anatomy and pathophysiology of the disease process . Conclusions: A timely, integrated, multidisciplinary approach to the patient with vertebrobasilar thrombosis can improve outcome, The use of thrombolytics in the treatment of vertebrobasilar occlusion holds p romise but the benefits have not yet been proven in a controlled, rand omized study.