title: Sequential combination of two intravenous thrombolytics (recombinant tissue plasminogen activator/tenecteplase) in a patient with stroke and cardioembolic basilar artery occlusion.
abstract: Stroke caused by acute occlusion of basilar artery (AOBA) produces high risk of death. In eligible patients, thrombolysis significantly reduces mortality and disability rate. In most hospitals, thrombolysis is limited to intravenous (IV) route of recombinant tissue plasminogen activator, without any therapeutic alternative in cases of treatment failure. We report a case of cardioembolic AOBA, not responsive to a conventional regimen of IV recombinant tissue plasminogen activator. A sequential combination of IV tenecteplase (0.4 mg/kg) led to a complete recanalization of basilar artery, with a very good clinical outcome. The potential for a combination of two successive IV regimens should be evaluated in AOBA.
authors.affiliation: Department of Neurology, University Hospital of Fort-de-France, Martinique, the French West Indies. didier.smadja@chu-fortdefrance.fr
authors.forename: Didier
authors.initials: D
authors.lastname: Smadja
authors.forename: Stéphane
authors.initials: S
authors.lastname: Olindo
authors.forename: Martine
authors.initials: M
authors.lastname: Saint-Vil
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chausson
mesh_terms: D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D004359:Drug Therapy, Combination; D004617:Embolism / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006331:Heart Diseases / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007262:Infusions, Intravenous; D018810:Magnetic Resonance Angiography; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D000077785:Tenecteplase; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase