SUCCESSFUL TREATMENT OF AN ACUTE THROMBOSIS OF AN INTRACRANIAL VERTEBRAL ARTERY ENDARTERECTOMY WITH UROKINASE

THIS IS A case report of a 47-year-old man admitted with a 7-month his tory of disequilibrium, multiple reversible vertebrobasilar ischemic a ttacks, and one submaximal completed stroke in the left posterior infe rior cerebellar artery distribution. Vertebrobasilar ischemic attacks continued despite anticoagulation, and orthostatic symptomatology sugg ested a significant hemodynamic component contributing to the posterio r circulation ischemia. Angiography confirmed bilateral high-grade ste noses of the intracranial vertebral arteries. A right intracranial ver tebral artery endarterectomy was performed with electroencephalographi c and somatosensory evoked potential monitoring and protection with ba rbiturate infusion. The arteriotomy was closed with a vein patch. Post operatively, the endarterectomy site thrombosed. This thrombosis was c ompletely reversed with 220,000 U of urokinase selectively infused int ra-arterially at the site of thrombosis. This procedure was not compli cated by hemorrhage or distal embolization. The vertebral artery was c onfirmed to be patent 24 hours and 7 days after the urokinase injectio n. The patient sustained a borderzone infarction in the right cerebell ar hemisphere without neurological deficits and was discharged home we ll.