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(Stroke. 2005;36:203.)
© 2005 American Heart Association, Inc.

Advances in Stroke 2004

Options for Recanalization Therapy in Basilar Artery Occlusion

From the Department of Neurology (P.J.L., L.S., R.O.R., T.T.), Helsinki University Central Hospital, Finland; and Neuroscience Program (P.J.L., T.T.), Biomedicum Helsinki, Finland.

Correspondence to Dr Perttu J. Lindsberg, Neuroscience Program, Biomedicum Helsinki, PO Box 700, 00029 HUS, Helsinki, Finland. E-mail perttu.lindsberg@hus.fi

Key Words: Advances in Stroke • basilar artery • outcome • thrombolysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Basilar artery occlusion (BAO) is a relatively infrequent but catastrophic disease with dismal natural course, carrying 85% to 95% mortality even during anticoagulant and fibrinolytic therapy if not recanalized.^1,2 The disease also poses a diagnostic challenge because it often starts with transient nonspecific prodromal symptoms, whereas complete BAO precipitates a sudden or gradually progressing multifaceted clinical syndrome consisting of bilateral motor weaknesses, bulbar symptoms, and disturbances of the visual system, motor coordination, and balance, as reviewed recently.³ To establish firm diagnosis, vascular imaging with computed tomographic or magnetic resonance angiography or conventional angiography is necessary. The most devastating disease phenotype is the locked-in state, which has been demonstrated to be reversed by rapid recanalization.⁴ Because of the infrequency and the clinical variability of the disease, it has been difficult to obtain evidence-based data on the true efficacy of recanalization therapies.^5,6 Instead of witnessing the natural course, some stroke centers have adopted interventive protocols to manage BAO, mostly with intra-arterial thrombolytics.

In vertebrobasilar occlusive disease, numerous reports advocate local delivery of the thrombolytic agent.^4,5,7 Several studies also found the delay in therapy onset to be a critical prognostic factor, apart from recanalization.^6,8 Introduction of an intra-arterial catheter to administer thrombolytics locally may at times be difficult and time-consuming, considering the often stenosed and elongated arteriosclerotic vertebral arteries, and can increase treatment delay if considered the sole therapy mode. Therefore, some centers have adopted routinely the intravenous approach similar to that used in the anterior circulation strokes.^9,10 The outcome reached with this . . . [Full Text of this Article]

This article has been cited by other articles:

				P. J. Lindsberg and H. P. Mattle Therapy of Basilar Artery Occlusion: A Systematic Analysis Comparing Intra-Arterial and Intravenous Thrombolysis Stroke, March 1, 2006; 37(3): 922 - 928. [Abstract] [Full Text] [PDF]