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(Stroke. 2006;37:2436.)
© 2006 American Heart Association, Inc.

Controversies in Stroke

Intra-Arterial Thrombolysis Is the Treatment of Choice for Basilar Thrombosis

Pro

Geoffrey A. Donnan, MD, FRACP; Stephen M. Davis, MD, FRACP, Section Editors:; Peter D. Schellinger, MD, PhD Werner Hacke, MD, PhD

From the Departments of Neurology, University of Erlangen (P.D.S.) and University of Heidelberg (W.H.), Germany.

Correspondence to Peter D. Schellinger, MD, PhD, Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, D-91054 Erlangen, Germany. E-mail Peter.Schellinger@neuro.imed.uni-erlangen.de

Key Words: thrombolysis

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

Parachutes to prevent death and disability from gravitational challenge.

The basis for parachute use is purely observational,

Apparent efficacy could be explained by a healthy cohort effect,

Individuals who insist that all interventions need to be validated by a RCT need to come down to earth with a bump.¹

Basilar artery thrombosis (BAT) is a rare but most severe subtype of ischemic stroke often presenting with progressive or hyperacute brain stem symptoms, tetraplegia and loss of consciousness ranging from somnolence to frank coma. It is associated with a mortality between 50% and 90% in patients treated conventionally (antiplatelets or heparin) or not at all.^2,3 If survived, the consequence frequently is a locked-in syndrome, the most gruelsome outcome thinkable. Different patterns include caudal vertebrobasilar, mid-basilar and top-of-the-basilar thrombosis, the former mostly being of atherothrombotic and the latter of embolic origin.⁴ Multiple case series mostly addressing intra-arterial (IA) and less frequently intravenous⁵ thrombolytic therapy for BAT have been published in the last 20 years, the first report by Zeumer et al dating back to 1982.^6,7 Most studies suffered from small numbers: <10 patients with only a few in the range of 40 to 50 patients.^2,8,9 All had an open, retrospective or partly prospective design with differing treatment regimens, mostly IA thrombolytic drugs formally rendering level III evidence at best.

Whereas some studies only used presence or absence of recanalization induced by a thrombolytic as a surrogate outcome, in all but 1 series it was shown that overall survival and an . . . [Full Text of this Article]

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