Long-term outcome after local intra-arterial fibrinolysis of basilar artery thrombosis

Thrombolytic therapy of acute basilar artery (BA) thrombosis has been shown to reduce mortality and avoid a fatal outcome. Objective of this study was to investigate the long-term clinical outcome following intra-arterial fib rinolysis of occlusions of the BA. We retrospectively analyzed the clinical records acid neuroradiologic results of 20 consecutive patients who had in tra-arterial fibrinolysis of acute occlusions of the BA between 1982 and 19 90. All patients were followed neurologically for a period of up to 12 year s, including assessment of the Barthel index (BI) and brain CT or MRI studi es. At the time of treatment, 6 patients were somnolent and 14 comatose, an d tetraparesis was present in 15. The time between the onset of symptoms an d treatment ranged from 1 to 48 h. The mortality rate was 35% (7/20 patient s). Functional outcome was excellent in 9, 78%, of 13 survivors (BI <85). D uring the cumulative follow-up period (125 patient years) there was 1 death from myocardial infarction and 1 death from pneumonia. Vascular events dur ing follow-up were myocardial infarction (n = 3) and a single cerebral tran sient ischemic attack. Despite the fact that our series was biased towards patients with severe symptoms, 65% (13/20) survived, and 78% of the survivo rs reached independence in daily life. These results provide evidence that local fibrinolysis of BA occlusion reduces mortality, and the long-term pro gnosis of the survivors is better than previously thought. None of our pati ents had a further stroke during the follow-up period, which indicates that acute BA occlusion is not a strong indicator for advanced arteriosclerotic disease. Copyroght (C) 2000 S. Karger AG, Basel.