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(Stroke. 2007;38:e29.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Therapy of Basilar Artery Occlusion: Individual Protocols Needed

Bijan Vatankhah, MD Felix Schlachetzki, MD

Department of Neurology, University of Regensburg, Regensburg, Germany

Heinrich J. Audebert, MD

Städtisches Klinikum München GmbH, München, Germany

To the Editor:

We read the recent article by Lindsberg and Mattle¹ about treatment in basilar artery occlusion (BAO) with great interest. Their conclusion about IV thrombolysis probably being similarly effective as intra-arterial application provoked the expected controversial debate by colleagues from different stroke centers.^2–8

Nevertheless, many patients with BAO are admitted to community hospitals without stroke units nor on-call neuroradiologists limiting both diagnostic and interventional options. Thus, the approach to treatment for such patients needs to be different. IV thrombolysis is an interesting alternative, but stroke expertise needs to be transferred to those hospitals in time. Recently, some telemedical networks with online patient examination in real-time and scan transmission like our German TEMPiS Project⁹ were established. They are aimed to bring stroke unit knowledge to those hospitals and to decrease the time until diagnosis and until treatment, eg, in BAO patients.

At the beginning of our project, the majority of the BAO patients in the community hospitals received anticoagulation and were transferred to the nearest stroke center by the fastest means of transport. We examined the interhospital duration of transport and found a disappointing 147 minutes from BAO diagnosis to arrival in the stroke centers on average.¹⁰ Having this information and Lindsberg’s study¹¹ in mind, we changed our policies and now start a "bridging" IV thrombolysis in the community hospitals. The patients get an angiography after arrival at the stroke centers. Further treatment like intra-arterial thrombolysis, mechanical devices or anticoagulation depends on the angiographical findings. So far, first experiences of this approach in out network are promising but need further validation. The combination of telemedical networks and early start of therapy might present a potential chance for those patients with an otherwise devastating chance of survival.

Acknowledgments

Disclosures

None.

References

1. Lindsberg PJ, Mattle HP. Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke. 37: 922–928.
2. Ciccone A, Scomazzoni F. Intra-arterial thrombolysis for acute ischemic stroke. Stroke. 2006; 37: 1962.[Free Full Text]
3. Lindsberg PJ, Mattle HP. Response to Letter by Ciccone et al. Stroke. 2006; 37: 1963.[Free Full Text]
4. Schonewille W, Wijman C, Michel P; BASICS investigators. Treatment and clinical outcome in patients with basilar artery occlusion. Stroke. 2006; 37: 2206.[Free Full Text]
5. Lindsberg PJ, Mattle HP. Response to Letter by Schonewille et al. Stroke. 2006; 37: 2207.[Free Full Text]
6. Schellinger PD, Hacke W. Intra-arterial thrombolysis is the treatment of choice for basilar thrombosis: pro. Stroke. 37: 2436–2437.
7. Ford GA. Intra-arterial thrombolysis is the treatment of choice for basilar thrombosis: con. Stroke. 37: 2438–2439.
8. Davis SM, Donnan GA. Basilar artery thrombosis: recanalization is the key. Stroke. 2006; 37: 2440.[Free Full Text]
9. Audebert HJ, Wimmer ML, Hahn R, Schenkel J, Bogdahn U, Horn M, Haberl RL; on behalf of TEMPIS Group. Can telemedicine contribute to fulfill WHO Helsingborg Declaration of specialized stroke care? Cerebrovasc Dis. 2005; 20: 362–369.[CrossRef][Medline] [Order article via Infotrieve]
10. Audebert HJ, Clarmann von Clarenau S, Schenkel J, Furst A, Ziemus B, Metz C, Haberl RL. Problemfeld der Notfallverlegungen beim Schlaganfall – Ergebnisse des telemedizinischen Pilotprojekts zur integrierten Schlaganfallversorgung in Südostbayern (TEMPiS). Dtsch Med Wochenschr. 2005; 130: 2495–2500.[CrossRef][Medline] [Order article via Infotrieve]
11. Lindsberg PJ, Soinne L, Tatlisumak T, Roine RO, Kallela M, Happola O, Kaste M. Long-term outcome after intravenous thrombolysis of basilar artery occlusion. JAMA. 2004; 292: 1862–1866.[Abstract/Free Full Text]

Related Article:

Response to Letter by Vatankhah et al

Perttu J. Lindsberg and Heinrich P. Mattle
Stroke 2007 38: e30. [Full Text] [PDF]

This Article Full Text (PDF) All Versions of this Article: 38/6/e29    most recent STROKEAHA.106.474908v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vatankhah, B. Articles by Audebert, H. J. Search for Related Content PubMed PubMed Citation Articles by Vatankhah, B. Articles by Audebert, H. J. Related Collections Related Article