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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:2042-2047, November-December 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Outcome of Acute Vertebrobasilar Occlusions Treated with Intra-Arterial Fibrinolysis in 180 Patients

G. Schulte-Altedorneburg^a, G.F. Hamann^b,e, M. Mull^c, D. Kühne^d, M. Liebetrau^b,e, W. Weber^d, H. Brückmann^a and T.E. Mayer^a

^a Department of Neuroradiology, University of Munich, Klinikum Grosshadern, Germany
^b Department of Neurology, University of Munich, Klinikum Grosshadern, Germany
^c Department of Neuroradiology, University of Aachen, Germany
^d Department of Neuroradiology, Alfried-Krupp Hospital Essen, Germany
^e Department of Neurology, Dr. Horst Schmidt Klinik GmbH, Wiesbaden, Germany

Address correspondence to Gernot Schulte-Altedorneburg, MD, Clinic of Diagnostic and Interventional Neuroradiology, University of Saarland, Klinikum, D-66421 Homburg/Saar, Germany; e-mail: gernot.sad{at}gmx.de

BACKGROUND AND PURPOSE: To evaluate predictors of recanalization and a favorable neurologic outcome in patients with acute vertebrobasilar occlusion (VBO) treated with local intra-arterial fibrinolysis (LIF).

METHODS: The multicentric data of 180 patients with acute VBO treated with LIF were retrospectively evaluated. The modified Rankin scale (mRS) was used to evaluate the neurologic status before LIF and at the time of discharge. Patient’s sex, age, etiology of VBO, recanalization, symptom duration before LIF, and pretreatment mRS were correlated with posttreatment mRS. Multiple logistic regression analysis was used to identify independent variables for recanalization and neurologic outcome.

RESULTS: The overall mortality was 43%. Complete recanalization was achieved in 99 (55%) patients and a partial recanalization in 35 (19%) patients, respectively. Recanalization was significantly associated with a favorable outcome (P < .001). The success of recanalization was negatively correlated with the volume of the thrombus (P < .001). No correlation was found between site and etiology of VBO and recanalization. Neurologic outcome correlated strongly with the pretreatment mRS (P < .001) and also with age (P < .02). Coma lasting less than 4.5 hours led to a positive trend toward a better outcome after univariate testing (P < .001).

CONCLUSIONS: Success of recanalization and neurologic status before treatment predict neurologic outcome in patients with VBO. Thrombus volume has an adverse effect on the recanalization success.

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