[Possibilities and limits of local intra-arterial fibrinolysis in thromboembolic vascular occlusions of the central nervous system].

Abstract

It is now possible with the help of microcatheters to superselectivity catheterize the cerebral vessels right up to the point of thromboembolic vascular occlusion. Short acting fibrinolytic agents such as urokinase and rt-PA are ideally suited for local intraarterial fibrinolysis (LIF) of thromboembolism in cerebral arteries. Despite high dosages (1,000,000-2,000,000 I.U. urokinase/hr), the risk of symptomatic haemorrhage is relatively low if therapy is started within 4-5 hours of the onset of symptoms and is administered only for a short time (1-2 hrs). To reduce the high mortality rate in patients with thromboembolic occlusion in the vertebrobasilar territory, LIF is the treatment of choice. If therapy is promptly started within 4-5 hours of the clinical onset of symptoms, a favourable clinical course may result even in patients with internal carotid artery or middle cerebral artery occlusions. However, further studies are required to optimize the treatment strategy in the latter group of patients. Results of studies to date have shown that the immediate intraarterial fibrinolysis of the acutely occluded central retinal artery is by far superior to conservative therapy.