Becker K J, Monsein L H, Ulatowski J, Mirski M, Williams M, Hanley D F
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
AJNR Am J Neuroradiol. 1996 Feb;17(2):255-62.
To report our experience using intraarterial thrombolysis in the treatment of vertebrobasilar occlusion.
Twelve patients with 13 angiographically proved thromboses of the vertebrobasilar system underwent local intraarterial thrombolysis with urokinase. Angiographic and clinical outcomes were analyzed with respect to clinical examination at presentation, arterial occlusion patterns, and time to recanalization.
The overall mortality was 75%. Recanalization could not be achieved in 3 of 13 treatments; all patients in whom recanalization failed died. The mortality rate was 60% in those patients in whom recanalization was successful. Coma or quadriparesis at the time of therapy uniformly predicted death. There were two cases each of bilateral proximal vertebral occlusions and midbasilar occlusions and nine cases of bilateral distal vertebral occlusions. There were three cases of fatal rethrombosis after initial successful thrombolysis. The mortality rate in the recanalized group before rethrombosis was 30%. There were two fatal hemorrhages of the central nervous system.
Recanalization of the vertebrobasilar system is necessary but not sufficient for effective treatment of vertebrobasilar occlusive disease. The site of occlusion may help predict angiographic and clinical outcome. Time to initiation of thrombolysis is not an invariable correlate of survival, although clinical condition at presentation may be. Rethrombosis and hemorrhage are significant problems affecting mortality after successful thrombolysis.
报告我们使用动脉内溶栓治疗椎基底动脉闭塞的经验。
12例经血管造影证实有13处椎基底动脉系统血栓形成的患者接受了尿激酶局部动脉内溶栓治疗。根据就诊时的临床检查、动脉闭塞模式及再通时间，分析血管造影和临床结果。
总死亡率为75%。13次治疗中有3次未能实现再通；所有再通失败的患者均死亡。再通成功的患者死亡率为60%。治疗时出现昏迷或四肢瘫均预示着死亡。有2例双侧近端椎动脉闭塞和2例基底动脉中段闭塞，9例双侧远端椎动脉闭塞。初次溶栓成功后有3例发生致命性再血栓形成。再血栓形成前再通组的死亡率为30%。有2例中枢神经系统致命性出血。
椎基底动脉系统再通对于有效治疗椎基底动脉闭塞性疾病是必要的，但并非充分条件。闭塞部位可能有助于预测血管造影和临床结果。溶栓开始时间并非生存的恒定相关因素，尽管就诊时的临床状况可能是。再血栓形成和出血是影响溶栓成功后死亡率的重要问题。
