Local intra-arterial fibrinolysis without arterial occlusion?

Local intra-arterial fibrinolysis (LIF) is the best choice at present for t reatment of acute vessel occlusion in the vertebrobasilar territory and als o, in selected cases, in the carotid territory. In almost all cases angiogr aphy demonstrates the site of occlusion exactly and gives information about collateral circulation. Contrary to this common approach, we report five p atients with severe acute thromboembolic stroke in whom angiography reveale d no occlusion of relevant arteries or their main branches. Under the hypot hesis of persisting occlusion of perforating arteries to the brain stem we performed LIF in patients with a clinical basilar artery syndrome. Outcome in all but one of them was good following LIF. The clinical details are des cribed and possible reasons discussed.