Efficacy of intraarterial thrombolysis of basilar artery stroke

Background: Stroke from basilar artery (BA) occlusion is a devastating neurological event with reported mortality rates of up to 90%. This series reports our experience in 15 cases using intraarterial (IA) thrombolysis to treat basilar artery stroke at the Oregon Stroke Center. Methods: Over a 4-year period, consecutive cases of basilar artery stroke were treated with IA urokinase (UK) if they met the following criteria: had a baseline National Institutes of Health Stroke Scale (NIHSS) score greater than 6; symptoms began within 48 hours; had no or minimal early infarct signs on computed tomography (CT) scan; and angiogram confirmed basilar occlusion. Patients were treated with UK infused via a microcatheter directly into the clot. Angiographic efficacy was assessed by a repeat angiogram at the end of infusion and clinical efficacy was determined by NIHSS evaluation at 48 hours and 3 months. Results: Fifteen patients, mean age 59 (16 to 78) and baseline NIHSS of 30 (7 to 40), were treated at a mean of 12 hours (4 to 48). An average dose of 500,000 (150,000 to 1,250,000) units of UK was given over 1 to 2 hours. Excellent vessel recanalization occurred in 12 of 15 (80%) patients. All three cases without recanalization died within 48 hours (100%). Of the 12 patients with recanalization, 2 died (16.7%), whereas the 9 of 10 remaining had mild or moderate neurological deficits (mean NIHSS of 5) at 3 months. Conclusion: IA thrombolysis has the potential to decrease mortality and improve outcome in cases with severe basilar artery stroke even when administered after 6 hours.