Thrombolysis in the Vertebrobasilar Circulation: The Australian Urokinase Stroke Trial
作者:
P.J. Mitchell,
R.P. Gerraty,
G.A. Donnan,
G. Fitt,
B.M. Tress,
K.R. Thomson,
S.M. Davis,
期刊:
Cerebrovascular Diseases
(Karger Available online 1997)
卷期:
Volume 7,
issue 2
页码: 94-99
ISSN:1015-9770
年代: 1997
DOI:10.1159/000108174
出版商: S. Karger AG
关键词: Basilar infarction;Therapy;Cerebral ischaemia;Clinical trials;Fibrinolysis;Thrombolysis;Urokinase
数据来源: Karger
摘要:
Stroke due to basilar artery occlusion has a high mortality and morbidity. Intra-arterial thrombolysis has been reported to improve survival and outcome status. Our aim was to assess the safety and efficacy of intra-arterial urokinase in a consecutive series of patients with clinically severe brainstem ischaemic stroke and major vertebrobasilar vessel occlusion. Incremental doses of urokinase were administered until clot lysis was achieved, or until a limit of 1,000,000 U. Patients were then anticoagulated with heparin and warfarin, and 6-month functional status was measured by the Barthel index. Sixteen patients, aged 22–73 (median 60), were treated 5–31 (median 15) h following symptom onset. Thirteen of the 16 patients (82%) had initial complete or partial recanalisation. Complete occlusion of the basilar artery was present in 13, and recanalisation was achieved in 10 of these (77%), although 2 re-occluded. Four of 5 patients with persistent occlusion died, compared with only 1 death in 8 patients with sustained recanalisation (p = 0.02, Fisher''s exact test, one-tailed). Intra-arterial urokinase can recanalise basilar artery occlusion, with significant reduction in mortality at 6 months. A prospective randomised, controlled trial is necessary to confirm the benefit of this ther
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