Journal article
Bleeding complications after basilar artery fibrinolysis with tissue plasminogen activator
American journal of neuroradiology : AJNR, Vol.22(3), pp.521-525
2001
PMID: 11237979
Abstract
Background and purpose: Fibrinolysis with local intraarterial urokinase infusion for basilar artery thrombosis has been associated with a low rate of spontaneous symptomatic cerebral hemorrhage, even when patients have been treated late in the course of symptoms. Because urokinase is presently unavailable in the United States, this study was undertaken to determine the frequency of spontaneous cerebral hemorrhage in basilar artery fibrinolysis performed with tissue plasminogen activator (tPA). Methods: In a retrospective review of our initial experience with cerebral fibrinolysis for acute stroke using intraarterial tPA, four cases of basilar thrombosis were identified. Doses of the fibrinolytic agent and heparin, angiographic findings, clinical courses, and bleeding complications for these patients were determined. These results were compared with those from a prior study of 20 similar consecutive patients treated with urokinase. Results: Symptom duration before treatment was unlimited. Intraarterial doses of tPA were 20 to 50 mg. Patients received full systemic anticoagulation with heparin. Complete basilar artery recanalization was achieved in 75% of patients. Two patients treated with tPA had angioplasty and stent placement for related high-grade stenosis. Spontaneous symptomatic cerebral hemorrhage occurred in three (75%) of the four tPA-treated patients and in three (15%) of the 20 urokinase-treated patients. Conclusion: The cerebral hemorrhage complication rate for intraarterial fibrinolysis with tPA was very high in cases of basilar artery thrombosis at the doses we used. Protocol adjustments should be considered.
Details
- Title: Subtitle
- Bleeding complications after basilar artery fibrinolysis with tissue plasminogen activator
- Creators
- Dewitte T CROSS - Department of Radiology, Box 8131, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, United StatesColin P DERDEYN - Department of Radiology, Box 8131, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, United StatesChristopher J MORAN - Department of Radiology, Box 8131, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, United States
- Resource Type
- Journal article
- Publication Details
- American journal of neuroradiology : AJNR, Vol.22(3), pp.521-525
- Publisher
- American Society of Neuroradiology; Oak Brook, IL
- PMID
- 11237979
- ISSN
- 0195-6108
- eISSN
- 1936-959X
- Language
- English
- Date published
- 2001
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020713502771
Metrics
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