[Experience with intra-arterial thrombolysis in patients with acute stroke]

The authors report on their results with local intraarterial thrombolysis in four patients.

Three patients suffered from vertebrobasilar artery occlusion, and one from carotid-T occlusion. All were treated with local intraarterial thrombolysis by a joint team of neurologist, neuroanaesthesist and interventional neuroradiologist in the stroke-department of St. Stephen Municipal Hospital in collaboration with National Institute of Neurosurgery. Selection of patients suitable for successful intraarterial thrombolysis has to be done in the neurological department with help of ultrasound and neurological examination and CT scan. Patients were transferred to the therapeutic angiosuit and interventional treatment was initiated immediately upon establishing the diagnosis. At least one million units of urokinase was infused directly into the embolus in each case.

Complete recanalisation was achieved in three of the four cases. That was associated with full recovery in two patients, in whom good collateral circulation and no signs of atherosclerotic lesions were found prior to treatment. Another patients has died despite of full recanalisation of the basilar artery. One patient survived after partial recanalisation of bilateral vertebral artery occlusion with mild residual tetraparesis.

Local intraarterial thrombolysis is effective and is associated with good clinical outcome in properly selected patients. Careful and accurate ultrasound diagnostics of the site of occlusion plays a significant role in proper patient selection. Although difficult, acute intraarterial thrombolysis can be organized in a timely fashion even utilizing the required facilities in two different institutions, providing that all efforts is being made by each party for the fast diagnosis and treatment initiation.