Treatment and Clinical Outcome in Patients With Basilar Artery Occlusion
To the Editor:
We read with great interest the recent article by Lindsberg and Mattle1 in which they found, in a review of published case series, that patients with basilar artery occlusion treated with intra-arterial and intravenous thrombolysis (IVT) have similar outcomes.
We wonder whether they also compared their 2 groups with patients treated with antithrombotic therapy alone (antiplatelets or anticoagulation). In a recent retrospective 3-center study of 82 patients with basilar artery occlusion this treatment resulted in a similar case fatality rate of 40% as reported after intra-arterial thrombolysis and IVT.2
In our view, a randomized clinical trial is needed to resolve the problem concerning which treatment should be preferred for basilar occlusion. For the best design of such a trial, we need clinical and radiological characteristics that help select patients who are most likely to benefit from acute interventions. For this purpose we initiated the BASICS (BASilar artery International Cooperation Study) registry, a worldwide, multicenter, prospective, observational study of patients with symptomatic, radiologically confirmed, basilar artery occlusion. Since November 2002, 280 patients have been included from 30 participating centers. Overall, 54% of patients have been treated with intra-arterial therapy, 8% with IVT, and 38% with antithrombotic therapy. We hope to have reached our target number of 500 patients in the next 2 years. New participating centers are welcome to join.
Lindsberg PJ, Mattle HP. Therapy of basilar artery occlusion. A systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke. 2006; 37: 922–928.
Schonewille WJ, Algra A, Serena J, Molina C, Kappelle LJ. Outcome in patients with basilar artery occlusion treated conventionally. J Neurol Neurosurg Psychiatry. 2005; 76: 1238–1241.