[Intra-arterial thrombolysis for acute angiographically proven occlusion in bifurcation of basilar artery. Case report].

In a 52 year-old male patient with a past history of two strokes, an occlusion of the basilar cerebral artery in the area of bifurcation into the posterior cerebral arteries was angiographically confirmed. Following an intra-arterial application of rt-PA a partial revascularization of the occluded posterior arteries was observed. After an interval of 8 hours rt-PA was administered again, resulting in a complete recanalization of the arteries. The patient's neurological state was stabilized but not improved, despite a systematic anti-thrombotic treatment. His sudden death on the 23rd day of treatment was caused by pulmonary embolism. A postmortem examination indicated a complete patency of the Willis circle. The basilar artery was unchanged, while within the posterior cerebral arteries only a moderate thickening of the intima and a small dissection of the internal elastic membrane were found. There was no evidence of bleeding into the CNS. It was assumed that thrombolysis had resulted in a total revascularization of the occluded region and was uncomplicated. Ischemic changes within the nervous tissue had probably developed before the thrombolytic treatment, and were responsible for the lack of improvement. The patient's death due to pulmonary embolus in spite of the continued anticoagulant treatment, and his history of strokes in the young age, suggested the presence of some coagulation system abnormalities that could not be detected because of the thrombolytic and anticoagulant drugs administration.