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(Stroke. 2007;38:701.)
© 2007 American Heart Association, Inc.

Try It or Trial It: Introduction

Intra-Arterial Thrombolytic Therapy for Acute Basilar Occlusion

Pro

Wade S. Smith, MD, PhD

From the Department of Neurology, University of California, San Francisco, Calif

Correspondence to Wade S. Smith, MD, PhD, Department of Neurology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0114. E-mail smithw{at}neurology.ucsf.edu

Abstract

Acute thromboembolic occlusion of the basilar artery accounts for 6% to 10% of large-vessel stroke in humans. Because of the brain region supplied by this artery, the case fatality rate is the highest for all ischemic stroke subtypes, ranging from 40% to 86%. Patients who undergo successful recanalization of the basilar artery by intra-arterial thrombolysis have lower mortality of 39%. Considering all published series, a consistent survival benefit is predicted by revascularization (mortality 87% nonrecanalized compared with 39% recanalized; P<0.001). Although no large randomized studies of revascularization for acute basilar artery occlusion have been performed, it is unlikely that endovascular efforts are inferior to the natural history of the disease, and it is likely that patients benefit from this aggressive approach.

Key Words: endovascular • locked-in state • posterior circulation • prognosis • t-PA • treatment • urokinase

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