Efficacy of Intra-Arterial Thrombolysis beyond 6 Hours in Patients with Acute Vertebrobasilar Occlusive Disease
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Background: Though intra-arterial (IA) thrombolysis of vertebrobasilar ischemia is known to be effective beyond 6 hours, there is still some controversy in its safety and efficacy. However, neuroradiological intervention with IA thrombolysis to date is the one of the lifesaving therapy that has demonstrated benefit with regard to mortality and outcome. The purpose of this study is to show the effectiveness of thrombolysis beyond 6 hours. Methods: We retrospectively collected data on 31 patients with thrombolysis of vertebrobasilar ischemia from March 2000 to March 2006. Among them, ten patients were excluded due to disagreement by family members, angiographically inaccessible lesion, or incomplete clinical information. Total 21 patients were enrolled, and we divided these patients into two groups according to thrombolysis within or beyond 6 hours [group A (n=13) vs. group B (n=8)]. Clinical profiles, radiological data, method of thrombolysis, and clinical outcome were compared. Results: Among 21 patients, 7 had IA chemical thrombolysis only and 14 had IA mechanical and/or chemical thrombolysis. Initial National Institutes of Health Stroke Scale (NIHSS) score was 16.7¡¾7.3 in group A and 18.3¡¾6.4 in group B. mRS at 3 months was 3.4¡¾2.0 in group A and 3.8¡¾1.8 in group B. Favorable outcome at 3 months (mRS 0-2) was 5 (38.5%) in group A and 3 (37.5%) in group B. Among angiographic findings, initial NIHSS score and initial grade of collateral circulation were the only predictors of good outcome (P=0.01, P=0.03). Conclusion: This study suggests that time window for IA thrombolysis of vertebro-basilar ischemia can be extended beyond 6 hours. Outcome of IA thrombolysis beyond 6 hours may be no worse than thrombolysis within 6 hours. (Korean Journal of Stroke 2007;9:46-50)
Abstract
Background: Though intra-arterial (IA) thrombolysis of vertebrobasilar ischemia is known to be effective beyond 6 hours, there is still some controversy in its safety and efficacy. However, neuroradiological intervention with IA thrombolysis to date is the one of the lifesaving therapy that has demonstrated benefit with regard to mortality and outcome. The purpose of this study is to show the effectiveness of thrombolysis beyond 6 hours. Methods: We retrospectively collected data on 31 patients with thrombolysis of vertebrobasilar ischemia from March 2000 to March 2006. Among them, ten patients were excluded due to disagreement by family members, angiographically inaccessible lesion, or incomplete clinical information. Total 21 patients were enrolled, and we divided these patients into two groups according to thrombolysis within or beyond 6 hours [group A (n=13) vs. group B (n=8)]. Clinical profiles, radiological data, method of thrombolysis, and clinical outcome were compared. Results: Among 21 patients, 7 had IA chemical thrombolysis only and 14 had IA mechanical and/or chemical thrombolysis. Initial National Institutes of Health Stroke Scale (NIHSS) score was 16.7¡¾7.3 in group A and 18.3¡¾6.4 in group B. mRS at 3 months was 3.4¡¾2.0 in group A and 3.8¡¾1.8 in group B. Favorable outcome at 3 months (mRS 0-2) was 5 (38.5%) in group A and 3 (37.5%) in group B. Among angiographic findings, initial NIHSS score and initial grade of collateral circulation were the only predictors of good outcome (P=0.01, P=0.03). Conclusion: This study suggests that time window for IA thrombolysis of vertebro-basilar ischemia can be extended beyond 6 hours. Outcome of IA thrombolysis beyond 6 hours may be no worse than thrombolysis within 6 hours. (Korean Journal of Stroke 2007;9:46-50)