TREATMENT OF FIBRINOLYSIS IN CASES OF ACU TE CEREBRAL INFARCTION

On the basis of our upon own results of local intra-arterial fibrinoly sis (LIF), this article gives a short overview of recently established thrombolytic therapy in acute ischemic stroke. Fifty patients with ac ute occlusions of vertebrobasilar arteries and 118 patients showing oc clusions of branches of the internal carotid artery were treated with LIF. The Occlusion type, occlusion site and successful recanalization were associated with a favorable outcome: 92 % of embolic occlusions i n the vertebrobasilar territory were recanalized and resulted in 50% i n a favorable outcome. In the carotid territory, optimal outcome was a chieved in main stem and branch occlusions of the middle cerebral arte ry, due to recanalization rates of 49 %-64 %. In contrast, occlusions of the intracranial bifurcation of the carotid artery (carotid-''T'') resulted in death in 59%. Despite the lack of randomized trials, LIF i s an established form of therapy in the vertebrobasilar territory. In the carotid territory randomized clinical studies could demonstrate th e efficacy of intravenous fibrinolytic therapy in some stroke patients . It can be presumed from pilot studies that LIF is superior to the in travenous version in the carotid territory.