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(Stroke. 2006;37:2438.)
© 2006 American Heart Association, Inc.

Controversies in Stroke

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

Con

Gary A. Ford, FRCP

From the UK Stroke Research Network, Consultant Stroke Physician, Newcastle University, United Kingdom.

Correspondence to Professor Gary A. Ford, Director, UK Stroke Research Network, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, United Kingdom. E-mail g.a.ford@newcastle.ac.uk

Key Words: thrombolysis

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

Strokes attributable to basilar artery occlusion are fortunately uncommon but have a high risk of death or severe disability. Presentation is highly variable, and initial misdiagnosis by nonspecialists of patients with warning or progressive symptoms is common. Sometimes patients present at a late stage where intervention is unlikely to be successful. Hence, management of these patients is particularly challenging to vascular neurologists and stroke physicians.

What do we know about basilar artery occlusion? As in anterior circulation ischemic strokes, "time is brain" and outcome depends on time to treatment, clinical state at presentation and whether and how quickly recanalization occurs. Without recanalization good recovery virtually never occurs. The rarity of basilar artery occlusion is reflected by the paucity of randomized controlled trials. One small randomized controlled trial of intra-arterial urokinase against anticoagulation in 16 patients with posterior circulation stroke suggested intra-arterial urokinase was associated with a better outcome.¹ However, the main evidence base available to decide on the most effective treatment approach comprises retrospective and prospective patient cohorts from different centers using a variety of protocols. Most case series report experience of using intra-arterial thrombolysis rather than intravenous thrombolysis or anticoagulation. That the management of intra-arterial thrombolyisis is controversial is therefore not surprising, because interpretation of nonrandomized evidence is difficult, and "reasonable" people can draw different conclusions.

The key to effective management of basilar artery occlusion has to be rapid diagnosis and early achievement of recanalization. However, attempts at reperfusion are sometimes attempted many hours after symptom onset when extensive . . . [Full Text of this Article]

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