Grond M, Rudolf J, Schmülling S, Stenzel C, Neveling M, Heiss W D
Department of Neurology, University Hospital of Cologne, Germany.
Arch Neurol. 1998 Apr;55(4):466-9. doi: 10.1001/archneur.55.4.466.
The optimal therapy of vertebrobasilar ischemic stroke is under debate. In the case of underlying basilar artery occlusion, intra-arterial thrombolysis is recommended. Because this pathologic condition is rarely found and the procedure is time consuming and restricted to specialized centers, the question arises whether early intravenous thrombolysis could also effectively be applied in vertebrobasilar ischemic stroke.
To determine if early intravenous thrombolysis could be used effectively in vertebrobasilar ischemic stroke.
A case series of 12 consecutive patients with acute vertebrobasilar ischemia were followed up 3 months after thrombolytic treatment at the Department of Neurology of the University Hospital of Cologne, Cologne, Germany, a primary care and referral center.
Patients with clinically diagnosed moderate to severe vertebrobasilar ischemic stroke with clearly determined symptom onset were treated with intravenous recombinant tissue-type plasminogen activator within 3 hours after symptom onset following a protocol similar to that of the National Institute of Neurological Disorders and Stroke study.
On admission, 7 patients exhibited moderate to severe brainstem symptoms without impairment of consciousness and 5 patients had impairment of consciousness, of whom 2 were comatose. Of 12 patients, 10 had a favorable outcome after 3 months defined as full independence (Barthel index score of 100) or return to premorbid condition. One patient had a poor outcome with complete dependency due to reocclusion after primarily successful thrombolysis, and 1 patient died of severe brainstem infarction and additional space occupying parietal hemorrhage.
Favorable outcome could be achieved in the majority of 12 consecutive patients with moderate to severe vertebrobasilar ischemic stroke treated with intravenous recombinant tissue-type plasminogen activator within 3 hours after symptom onset.
椎基底动脉缺血性卒中的最佳治疗方法仍存在争议。对于存在基底动脉闭塞的情况，推荐行动脉内溶栓治疗。由于这种病理状况很少见，且该操作耗时且仅限于专业中心，因此出现了早期静脉溶栓是否也能有效应用于椎基底动脉缺血性卒中的问题。
确定早期静脉溶栓是否能有效用于椎基底动脉缺血性卒中。
在德国科隆大学医院神经内科（一家初级保健和转诊中心），对12例连续的急性椎基底动脉缺血患者进行了溶栓治疗后3个月的随访，形成了一个病例系列。
对临床诊断为中度至重度椎基底动脉缺血性卒中且症状发作时间明确的患者，在症状发作后3小时内按照与美国国立神经疾病和卒中研究所研究相似的方案，静脉注射重组组织型纤溶酶原激活剂进行治疗。
入院时，7例患者表现出中度至重度脑干症状但意识未受损，5例患者有意识障碍，其中2例昏迷。12例患者中，10例在3个月后预后良好，定义为完全独立（巴氏指数评分为100）或恢复到病前状态。1例患者因初次溶栓成功后再闭塞而导致完全依赖，预后不良，1例患者死于严重脑干梗死及额外的顶叶占位性出血。
12例连续的中度至重度椎基底动脉缺血性卒中患者在症状发作后3小时内接受静脉注射重组组织型纤溶酶原激活剂治疗，大多数患者预后良好。
