Prolonged low-dose intravenous thrombolysis in a stroke patient with distal basilar thrombus.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Veltkamp
Roland
R
Department of Neurology, Ruprecht-Karls-University Heidelberg, Germany. roland_veltkamp@med.uni-heidelberg.de
Jacobi
Christian
C
Kress
Bodo
B
Hacke
Werner
W
D000368:Aged; D003251:Constriction, Pathologic; D004617:Embolism / Q000473:pathology; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D015424:Reperfusion; D012306:Risk; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014715:Vertebrobasilar Insufficiency / Q000628:therapy
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator