Background: Patients with ischaemic stroke due to occlusion of the basilar or vertebral arteries may develop a rapid deterioration in neurological status leading to coma and often to death. While intra-arterial thrombolysis may be used in this context, no randomised controlled data exist to support its safety or efficacy. Methods: Randomised controlled trial of intra-arterial urokinase within 24 h of symptom onset in patients with stroke and angiographic evidence of posterior circulation vascular occlusion. Results: Sixteen patients were randomised, and there was some imbalance between groups, with more severe strokes occurring in the treatment arm. A good outcome was observed in 4 of 8 patients who received intra-arterial urokinase compared with 1 of 8 patients in the control group. Conclusions: These results support the need for a large-scale study to establish the efficacy of intra-arterial thrombolysis for acute basilar artery occlusion.

Archer CR, Horenstein S: Basilar artery occlusion: Clinical and radiological correlation. Stroke 1977;8:383–390.
Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ: Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 1988;19:1216–1222.
Kunze I, Glahn J, Busse O: Heparin therapy in embolic cerebral infarct. A retrospective study (in German). Nervenarzt 1991;62:477–482.
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1588.
Stroke Trials Directory:
Yang Y, Li Q, Miyashita H, Howlett W, Siddiqui M, Shuaib A: Usefulness of postischemic thrombolysis with or without neuroprotection in a focal embolic model of cerebral ischemia. J Neurosurg 2000;92:841–847.
Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al: Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: A randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 1999;282:2003–2011.
Wechsler LR, Roberts R, Furlan AJ, Higashida RT, Dillon W, Roberts H, et al: Factors influencing outcome and treatment effect in PROACT II. Stroke 2003;34:1224–1229.
Zeumer H, Hacke W, Kolmann HL, Poeck K: Lokale Fibrinolysetherapie bei Basilaristhrombose. Dtsch Med Wochenschr 1982;107:728–731.
Brandt T, von Kummer R, Muller-Kuppers M, Hacke W: Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 1996;27:875–881.
Becker KJ, Monsein LH, Ulatowski J, Mirski M, Williams M, Hanley DF: Intraarterial thrombolysis in vertebrobasilar occlusion. AJNR Am J Neuroradiol 1996;17:255–262.
Arnold M, Nedeltchev K, Schroth G, Baumgartner RW, Remonda L, Loher TJ, et al: Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis. J Neurol Neurosurg Psychiatry 2004;75:857–862.
Ostrem JL, Saver JL, Alger JR, Starkman S, Leary MC, Duckwiler G, et al: Acute basilar artery occlusion: Diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies. Stroke 2004;35:e30.
Mitchell PJ, Gerraty RP, Donnan GA, Fitt G, Tress BM, Thomson KR, et al: Thrombolysis in the vertebrobasilar circulation – The Australian Urokinase Stroke Trial (AUST) Pilot Study. Cerebrovasc Dis 1997;7:94–99.
Berge E, Sandercock P: Anticoagulants versus antiplatelet agents for acute ischaemic stroke (Cochrane review). The Cochrane Library Issue 2. Chichester, Wiley & Sons, 2004.
Mayer TE, Hamann GF, Brueckmann HJ: Treatment of basilar artery embolism with a mechanical extraction device: Necessity of flow reversal. Stroke 2002;33:2232–2235.
Berlis A, Lutsep H, Barnwell S, Norbash A, Wechsler L, Jungreis CA, et al: Mechanical thrombolysis in acute ischemic stroke with endovascular photoacoustic recanalization. Stroke 2004;35:1112–1116.
Alexandrov AV, Demchuk AM, Burgin WS, Robinson DJ, Grotta JC for the CLOTBUST Investigators: Ultrasound-enhanced thrombolysis for acute ischemic stroke: Phase I. Findings of the CLOTBUST trial. J Neuroimaging 2004;14:113–117.
Lin DDM, Gailloud P, Beauchamp NJ, Aldrich EM, Wityk RJ, Murphy KJ: Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke. AJNR Am J Neuroradiol 2003;24:1827–1833.
Lindsberg PJ, Soinne L, Tatlisumak T, Roine RO, Kallela M, Happola O, Kaste M: Long-term outcome after intravenous thrombolysis of basilar artery occlusion. JAMA 2004;292:1862–1866.
Cross III DT, Derdeyn CP, Moran CJ: Bleeding complications after basilar artery fibrinolysis with tissue plasminogen activator. AJNR Am J Neuroradiol 2001;22:521–525.
Higashida RT, Furlan AJ, et al: Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003;34:e109–137.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.