Document Detail

Bleeding complications after basilar artery fibrinolysis with tissue plasminogen activator.
MedLine Citation:
PMID:  11237979     Owner:  NLM     Status:  MEDLINE    
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.
D T Cross; C P Derdeyn; C J Moran
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  22     ISSN:  0195-6108     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2001 Mar 
Date Detail:
Created Date:  2001-03-12     Completed Date:  2001-06-14     Revised Date:  2008-02-14    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  521-5     Citation Subset:  IM    
Department of Radiology, Box 8131, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA.
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MeSH Terms
Basilar Artery* / drug effects
Cerebral Hemorrhage / chemically induced*,  radiography
Fibrinolytic Agents / adverse effects*,  therapeutic use
Injections, Intra-Arterial
Intracranial Thrombosis / drug therapy*
Middle Aged
Retrospective Studies
Stroke / drug therapy*
Tissue Plasminogen Activator / adverse effects*,  therapeutic use
Tomography, X-Ray Computed
Reg. No./Substance:
0/Fibrinolytic Agents; EC Plasminogen Activator

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