[Intra-arterial thrombolysis of vessels supplying the brain]

Intraarterial thrombolytic therapy can be life-saving in patients with vertebrobasilar occlusion. Thrombotic occlusions of the internal carotid artery or middle cerebral artery often result in disabling ischemic cerebral infarctions. Local fibrinolysis may help to minimize the neurological sequelae. Indications and contraindications for such a therapy are not yet well established, and more discussion is needed. During the last 2 years we have treated 18 patients with occlusions of vessels supplying the brain by means of local intraarterial thrombolytic therapy with urokinase. These included 5 patients who presented with internal carotid/middle cerebral artery occlusions, 3 of whom left the hospital with only minor neurological deficits while 2 died despite therapy. The other 13 patients had acute vertebrobasilar occlusion: 6 patients survived, 3 with a good general condition and 2 with locked-in syndrome. Technique, dosage of urokinase and patient selection are discussed as well as the outcome.