Thrombolysis and angioplasty for acute occlusion of intracranial vertebrobasilar arteries. Report of three cases.

Abstract

Three cases of intracranial vertebrobasilar occlusion were successfully treated in the acute stage by thrombolysis and angioplasty. All three patients were admitted to the hospital because of consciousness disturbance and other brainstem signs. Initial angiography revealed intracranial vertebrobasilar occlusions. At first, a microcatheter was introduced into the distal site of the occlusion and thrombolysis was attempted by using urokinase. Recanalization was achieved in all cases but severe stenosis of the intracranial vertebral and basilar arteries was found. The recanalization was followed by transluminal balloon angioplasty and the stenosis was successfully resolved. Marked neurological improvement was achieved in each case. Follow-up cerebral angiography demonstrated sufficient patency at the angioplasty site after 3 to 6 months. Residual severe stenosis of vertebrobasilar arteries after thrombolytic therapy carries the possibility of reocclusion. Combining angioplasty with thrombolysis to avoid rethrombosis and obtain sufficient distal blood flow is of significant benefit in treating vertebrobasilar occlusion.