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(Stroke. 2006;37:e9.)
© 2006 American Heart Association, Inc.

Case Reports

Prolonged Low-Dose Intravenous Thrombolysis in a Stroke Patient With Distal Basilar Thrombus

From the Departments of Neurology (R.V., C.J., W.H.) and Neuroradiology (B.K.), Ruprecht-Karls University Heidelberg, Germany.

Correspondence to Roland Veltkamp, MD, Department of Neurology, Ruprecht-Karls-University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. E-mail roland_veltkamp{at}med.uni-heidelberg.de

Abstract

Background and Purpose— Patients with high-grade basilar artery stenosis secondary to thromboembolism are at high risk of developing subsequent vessel occlusion. Optimal medical management of this condition is unclear.

Summary of Case— We present a patient with a small subacute brain stem infarction and filiform distal basilar residual lumen attributable to arterioarterial or cardiogenic embolism. Beginning 3 days after symptom onset, low-dose intravenous thrombolysis with 0.125 mg/kg recombinant tissue plasminogen activator was continuously infused for 48 hours. Follow-up magnetic resonance angiography revealed complete resolution of the embolus. No further cerebral ischemic episodes occurred during 3-month follow-up, and the basilar artery remained patent.

Conclusion— Our observation suggests a potential for prolonged low-dose intravenous thrombolysis in basilar artery embolism, but further data are needed to judge the effectiveness and risk of this intervention.

Key Words: ischemia • magnetic resonance imaging • reperfusion • thrombolysis

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