Published Online
on December 8, 2005

A more recent version of this article appeared on January 1, 2006

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Submitted on July 9, 2005
Revised on August 26, 2005
Accepted on October 12, 2005

Mechanical Thrombolysis in Ischemic Stroke Attributable to Basilar Artery Occlusion as First-Line Treatment

Mauro Bergui MD^*; Guido Stura MD; Dino Daniele MD; Paolo Cerrato MD; Maurizio Berardino MD; and Gianni Boris Bradac MD

From the Neuroradiology (M. Bergui), Neurology (P.C.), and Intensive Care Unit (M. Berardino), Neuroscience Department, S.G. Battista Hospital, University of Turin, Italy.

^* To whom correspondence should be addressed. E-mail: mauro.bergui{at}unito.it.

Background and Purpose--To report results of mechanical disruption or retrieval of thrombus as first-line treatment in patients with stroke attributable to occlusion of the basilar artery, in particular regarding efficiency and safety.

Methods--In 12 consecutive patients with acute stroke attributable to basilar occlusion, mechanical disruption or thrombus retrieval using various loop-shaped tools was tried before eventually starting local intra-arterial thrombolysis with recombinant tissue plasminogen activator (r-tPA). Main inclusion criteria were: National Institutes of Health Stroke Scale score >8 or Glasgow Coma Scale score <12; onset or worsening of symptoms <8 hours; no hemorrhages or large hypodensities on computed tomography scan; and occlusion of the basilar artery matching clinical symptoms. Efficiency included recanalization, procedure time, and r-tPA dose; safety was defined as rate of procedure-related complications. Outcome was evaluated at 3 months.

Results--Mechanical recanalization was successful in 6 patients. A single brain infarction, possibly attributable to distal embolization, occurred. Three patients had good outcomes. In 5 of 6 remaining patients, the artery was recanalized using r-tPA. A single asymptomatic hemorrhage occurred; 3 patients had good outcomes. Procedure time and r-tPA were significantly less in patients with successful mechanical thrombolysis (43.33 minutes and 13.33 mg versus 112.33 minutes and 55.83 mg, respectively).

Conclusion--Mechanical recanalization was effective in half of the patients and at least as safe as local intra-arterial thrombolysis. It allowed to save r-tPA and time. Although the low success rate remains a limit, the excellent and quick anatomical recanalization obtained after successful procedures makes this approach promising.

Key words: brain stem • stroke • stroke, acute • thrombolytic therapy

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