Ezaki Yasuyuki, Tsutsumi Keisuke, Onizuka Masanari, Kawakubo Junichi, Yagi Nobuhiro, Shibayama Akira, Toba Tamotsu, Koga Hiroaki, Miyazaki Hisaya
Department of Neurosurgery, Sankokai Miyazaki Hospital, Nagasaki City, Japan.
Surg Neurol. 2003 Nov;60(5):423-9; discussion 429-30. doi: 10.1016/s0090-3019(03)00450-6.
Basilar artery occlusion usually has a very poor outcome and is associated with a high mortality rate. Local intra-arterial thrombolysis may improve the clinical outcome and reduce mortality in the treatment of acute basilar artery occlusion. We evaluated the possible variables affecting recanalization and clinical outcome in patients with basilar artery occlusions undergoing thrombolytic therapy.
We analyzed retrospectively the clinical course and outcome of a series of 26 patients between 1998 and 2001. All patients who were examined within 24 hours after onset of symptoms underwent emergency cerebral angiography and subsequent intra-arterial thrombolysis. Three patients additionally received percutaneous transluminal angioplasty of underlying stenosis at the site of thrombosis.
Outcome was good in 9 patients (34.6%) and poor in 17 (65.4%). Recanalization could be achieved in 24 patients (92.3%) and was not affected by age, sex, site of occlusion, etiology, thrombolytic drugs, or time interval. Good outcome was associated with younger age, good initial clinical condition, and no evidence of brain stem infarction. There was no association between the interval (greater or less than 6 hours) from the onset of symptoms until the end of thrombolysis and survival.
We confirm that intra-arterial thrombolysis reduces mortality in basilar artery occlusion. Young patients (<75 years) without any infarct in brain stem before the start of treatment seem to be the ideal candidates for thrombolysis. Basilar artery thrombosis could and should be reopened, even late (after 6 hours) after symptom onset.
基底动脉闭塞通常预后很差，死亡率很高。局部动脉内溶栓可能改善急性基底动脉闭塞治疗的临床结局并降低死亡率。我们评估了接受溶栓治疗的基底动脉闭塞患者中影响再通和临床结局的可能变量。
我们回顾性分析了1998年至2001年间26例患者的临床病程和结局。所有在症状发作后24小时内接受检查的患者均接受了急诊脑血管造影及随后的动脉内溶栓治疗。3例患者还在血栓形成部位接受了潜在狭窄的经皮腔内血管成形术。
9例患者（34.6%）预后良好，17例（65.4%）预后不良。24例患者（92.3%）实现了再通，再通不受年龄、性别、闭塞部位、病因、溶栓药物或时间间隔的影响。良好的结局与较年轻的年龄、良好的初始临床状况以及无脑干梗死证据相关。从症状发作到溶栓结束的时间间隔（大于或小于6小时）与生存率之间无关联。
我们证实动脉内溶栓可降低基底动脉闭塞的死亡率。治疗开始前无脑干梗死的年轻患者（<75岁）似乎是溶栓的理想人选。即使在症状发作后较晚（6小时后），基底动脉血栓也能够且应该再通。
