Timing of recanalization after microbubble-enhanced intravenous thrombolysis in basilar artery occlusion.
OBJECTIVE
Information about early recanalization of basilar artery occlusion after systemic tissue plasminogen activator remains unknown. We aimed to determine the timing of recanalization in basilar artery occlusion treated with systemic thrombolysis, microbubbles, and continuous transcranial Doppler monitoring.


METHODS
We studied 20 patients with <12 hours basilar artery occlusion treated with intravenous tissue plasminogen activator, 2 hours continuous ultrasound, and 3 boluses of microbubbles. Transcranial Doppler assessed recanalization at different time points. Outcome was assessed using the National Institutes of Health Stroke Scale and modified Rankin scale. Patients were considered to be independent if modified Rankin scale score was <3 at 90 days.


RESULTS
Median admission National Institutes of Health Stroke Scale was 18.5 (interquartile range 16 to 26.5) and median time to treatment was 180 minutes (range, 80 to 720 minutes). Rate of complete recanalization raised progressively: at 1 hour 10%, at 2 hours 20%, at 6 hours 35%, and at 24 hours 50%. In 10 patients (50%), no recanalization was observed at 24 hours. Median discharge National Institutes of Health Stroke Scale was 14 (interquartile range 1 to 30). Degree of National Institutes of Health Stroke Scale improvement was related to time of recanalization: median discharge National Institutes of Health Stroke Scale--1 for recanalization between 0 and 6 hours, 11 for recanalization between 6 and 24 hours, and 30 if no recanalization occurred (P=0.002). At 3 months, mortality was 35%. Only one patient (10%) who recanalized within 24 hours died as compared with 60% of nonrecanalizers (P=0.029). Rate of independent patients progressively decreased as time to recanalization increased (P=0.006).


CONCLUSIONS
In acute basilar artery occlusion, endovenous tissue plasminogen activator, microbubbles, and continuous ultrasound leads to early recanalization in a significant number of patients and this is associated with favorable outcome. Immediate intravenous tissue plasminogen activator treatment should be the first therapeutic option in these patients.
Pagola
Jorge
J
Unitat Neurovascular Vall d'Hebron, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain.
Ribo
Marc
M
Alvarez-Sabín
José
J
Lange
Marcos
M
Rubiera
Marta
M
Molina
Carlos A
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods* / Q000592:standards; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014654:Vascular Patency / Q000187:drug effects* / Q000502:physiology; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator