Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis.
OBJECTIVE
Basilar artery occlusion (BAO) is an infrequent form of acute stroke, which invariably leads to death or long-term disability if not recanalized. A traditional recanalization approach based on historical controls and pathophysiological consideration is local intra-arterial thrombolysis (IAT) in eligible patients. This necessitates diagnostic evaluation and treatment in stroke centers equipped with an interventional neuroradiological service on a 24-hour basis, but its superiority to the technically simple intravenous thrombolysis (IVT) remains unproven.


METHODS
We analyzed systematically published case series of substantial size reporting the outcome of BAO after IAT or IVT.


RESULTS
In 420 BAO patients treated with IVT (76) and IAT (344), death or dependency were equally common: 78% (59 of 76) and 76% (260 of 344), respectively (P=0.82). Recanalization was achieved more frequently with IAT (225 of 344; 65%) than with IVT (40 of 76; 53%; P=0.05), but survival rates after IVT (38 of 76; 50%) and IAT (154 of 344; 45%) were equal (P=0.48). A total of 24% of patients treated with IAT and 22% treated with IVT reached good outcomes (P=0.82). Without recanalization, the likelihood of good outcome was close to nil (2%).


CONCLUSIONS
Recanalization occurs in more than half of BAO patients treated with IAT or IVT, and 45% to 55% of survivors regain functional independence. Although improved therapy forms for BAO are necessary, hospitals not equipped for IAT may set up IVT protocols. The effect of IVT is probably not much different from the effect of IAT. IVT represents probably the best treatment that can be offered to victims of acute BAO in such hospitals.
Lindsberg
Perttu J
PJ
Department of Neurology, Neurosciences Program, Biomedicum Helsinki, Helsinki, Finland. perttu.lindsberg@hus.fi
Mattle
Heinrich P
HP
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D001488:Basilar Artery / Q000473:pathology*; D020520:Brain Infarction / Q000473:pathology; D002545:Brain Ischemia / Q000473:pathology; D001933:Brain Stem / Q000473:pathology; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D020521:Stroke / Q000473:pathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator