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(Stroke. 2008;39:1496.)
© 2008 American Heart Association, Inc.

Original Contributions

Staged Escalation Therapy in Acute Basilar Artery Occlusion

Intravenous Thrombolysis and On-Demand Consecutive Endovascular Mechanical Thrombectomy: Preliminary Experience in 16 Patients

Thomas Pfefferkorn, MD; Thomas E. Mayer, MD; Christian Opherk, MD; Nils Peters, MD; Andreas Straube, MD; Hans-Walter Pfister, MD; Markus Holtmannspötter, MD; Stefanie Müller-Schunk, MD; Martin Wiesmann, MD Martin Dichgans, MD

From Department of Neurology (T.P., C.O., N.P., A.S., H.W.P., M.D.) and Department of Neuroradiology (T.E.M., M.H., S.M.-S., M.W.), Klinikum Grosshadern, University of Munich, Germany.

Correspondence to Thomas Pfefferkorn, MD, Klinikum Grosshadern, Department of Neurology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany. E-mail Thomas.Pfefferkorn{at}med.uni-muenchen.de

Background and Purpose— The prognosis of acute basilar artery occlusion (BAO) is poor if early recanalization is not achieved. Recanalization strategies include intravenous thrombolysis (IVT) and intra-arterial thrombolysis, as well as endovascular mechanical thrombectomy (EMT). The combination of IVT with consecutive on-demand EMT may allow for early treatment initiation with high recanalization rates but has never been systematically tested in patients with BAO.

Methods— Starting in January 2006, we treated all eligible patients with acute BAO admitted to our academic stroke center or one of our cooperating community hospitals after a standardized protocol combining IVT with consecutive on-demand EMT. Inclusion criteria were: (1) presence of predefined symptoms clearly suggestive of BAO; (2) exclusion of intracerebral hemorrhage on CT scan; (3) evidence of BAO on CT angiography; (4) start of therapy within 6 hours after symptom onset; and (5) no contraindications for IVT. If CT angiography showed persistent BAO after IVT, EMT was performed.

Results— Since January 2006, 16 patients have been treated. All patients received IVT; in 7 of them, EMT became necessary because of persistent BAO. Final recanalization was achieved in 15 patients. Three months after therapy, 12 of 16 patients were still alive; 7 of them had a good outcome (modified Rankin score 2).

Conclusions— Our data suggest that the combination of IVT with on-demand consecutive EMT in BAO is feasible, allows for early treatment, and provides excellent recanalization rates.

Key Words: basilar artery occlusion • mechanical thrombectomy • thrombolysis

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