[Intra-arterial fibrinolysis in vertebrobasilar system]

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Acute vertebrobasilar occlusion is a life-threatening condition with high mortality and disability rates.
• Conventional treatments like heparin and selective fibrinolysis show limited efficacy.
• Local intra-arterial fibrinolysis is emerging as a primary treatment for basilar artery or intracranial vertebral artery occlusion.

Observation:

• A 63-year-old male presented with probable cardioembolic vertebrobasilar thrombosis.
• Treatment involved local intra-arterial fibrinolysis using recombinant tissue plasminogen activator (r-TPA).
• Post-treatment imaging revealed hemorrhagic transformation in the brainstem; the patient developed tetraparesis and cranial nerve palsy.

Findings:

• Local intra-arterial fibrinolysis demonstrated effectiveness in achieving recanalization of the vertebrobasilar system.
• Despite a hemorrhagic complication, the procedure offered a survival advantage compared to the natural history of the disease.
• Neurological outcomes are influenced by factors including thrombus location, patient's neurological status, and treatment timing.

Implications:

• Local intra-arterial fibrinolysis is the treatment of choice for vertebrobasilar thrombosis due to high morbidity and mortality.
• Improved emergency response and increased resource allocation are crucial for managing ischemic cerebral disease.
• This therapeutic strategy can potentially decrease mortality and reduce long-term disability associated with vertebrobasilar occlusions.