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(Stroke. 2007;38:721.)
© 2007 American Heart Association, Inc.

Try It or Trial It: Introduction

Intra-Arterial Thrombolysis for Basilar Artery Thrombosis and Stenting for Asymptomatic Carotid Disease

Implications and Future Directions

Vladimir Hachinski, MD, DSc

From the Department of Clinical Neurological Sciences, London Health Sciences Center, University Hospital, London, Ontario, Canada.

Correspondence to Vladimir Hachinski, Department of Clinical Neurological Sciences, London Health Sciences Center, University Hospital, 339 Windermere Road, London, Ontario, N6A 5A5, Canada. E-mail Vladimir.hachinski@lhsc.on.ca

Key Words: asymptomatic carotid stenosis • stenting • thrombolysis • thrombosis

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

Where knowledge fails controversies thrive. This applies particularly to techniques in evolution. Intra-arterial thrombolysis (IAT) for basilar artery thrombosis and stenting for asymptomatic carotid disease share 3 characteristics: they are operator-dependent, technology-intensive and expensive. Although IAT and stenting imply a similar approach, the clinical problems that they address differ radically. IAT is unscheduled and dramatic, the interventionalist hoping for something to happen, namely recanalization and improvement, whereas stenting for asymptomatic carotid disease is scheduled and undramatic, the interventionalist hopes that nothing happens, either during the procedure, or thereafter (ie, no stroke).

IAT for Basilar Artery Thrombosis

We have no accurate data on the natural history of basilar thrombosis, but from the published literature, a perception persists that the usual prognosis appears so dismal that almost any intervention can be justified.¹

The natural history of asymptomatic carotid disease is much better known,² being benign enough to call into question the need for any invasive procedure.

Basilar thrombosis can lead to desperate situations, calling for desperate measures. One is justified in trying to do something about the natural history, but only if it can be done systematically. Otherwise, we are performing a potentially harmful, costly procedure with no evidence of benefit, and with the potential for harm. By not evaluating what we do, we perpetuate and inflict our dangerous ignorance on future patients.

A rationale can be made for using thrombolysis in basilar occlusion. It may be life-saving and decrease disability. The complications can be predicted, generically but not individually. The treatment could make the patient worse, . . . [Full Text of this Article]

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