The accuracy and the reliability of extracranial vertebral Doppler flow (continuous wave Doppler sonography) for the detection of intracranial vertebrobasilar lesions was studied prospectively in twenty-one patients with brainstem disturbances and/or coma. The Doppler findings were compared with cerebral angiography. Doppler sonography was highly reliable for both detection and exclusion of high grade intracranial vertebrobasilar lesions. The pathognomonic Doppler finding was an abrupt deceleration of the blood column during systole and stoppage or even reflux during diastole. The same blood flow alterations were found in two additional illustrative cases having therapeutically or brain-death induced blockages of the vertebral arteries. The pathophysiologic mechanisms of flow disturbances and the limitations of Doppler sonography in this area are discussed.

Arterial Occlusive Diseases↗

PubMedDate not supplied

Intraarterial thrombolytic therapy in acute stroke.

Intraarterial thrombolytic therapy by means of urokinase has proved to be effective and safe in certain instances of acute thromboembolic occlusion of the vertebral and/or the basilar artery. Small hemorrhages have not led to deterioration in the patients' neurological state. In the territory of the carotid artery local thrombolytic therapy may be effective in very selected cases of acute thromboembolic occlusion. There is a high risk of intracerebral hemorrhage. Possibly intravenous administration of tPA will replace local intraarterial thrombolysis, provided a strict regimen is established for selection of patients, determination of dosage and time constraints for the application of this therapy.

Arterial Occlusive Diseases↗