RELATIONSHIP BETWEEN CLOT LOCATION AND OUTCOME AFTER BASILAR ARTERY THROMBOLYSIS

PURPOSE: To identify factors that predict survival and good neurologic outcome in patients undergoing basilar artery thrombolysis. METHODS: Over a 42-month period, 20 of 22 consecutive patients with angiographi c proof of basilar artery thrombosis were treated with local intraarte rial urokinase, Brain CT scans, neurologic examinations, symptom durat ion, clot location, and degree of recanalization were analyzed retrosp ectively. RESULTS: Overall survival was 35% at 3 months. Survival in p atients with only distal basilar clot was 71%, while survival in patie nts with proximal or midbasilar clot was only 15%. At 3 months, 29% of patients with distal basilar clot and 15% of patients with proximal o r midbasilar clot had good neurologic outcomes (modified Rankin score of 0 to 2 and Barthel index of 95 to 100). Complete recanalization was achieved in 50% of patients; 60% of those survived and 30% had good n eurologic outcomes. Of patients with less than complete recanalization , only 10% survived. Neither duration of symptoms before treatment (ra nge, 1 to 79 hours), age (range, 12 to 83 years), nor neurologic statu s at the initiation of treatment (Glasgow Coma Scale score range, 3 to 15) predicted outcome. Pretreatment CT findings (positive or negative for related ischemic changes) did not predict outcome or hemorrhagic transformation. CONCLUSION: The single best predictor of survival afte r basilar thrombosis and intraarterial thrombolysis was distal clot lo cation. Complete recanalization favored survival. Radiologically evide nt related infarctions, advanced age, delayed diagnosis, and poor pret reatment neurologic status did not predict poor outcome and therefore should not be considered absolute contraindications for intraarterial thrombolysis in patients with basilar artery thrombosis.