Sequential combination of two intravenous thrombolytics (recombinant tissue plasminogen activator/tenecteplase) in a patient with stroke and cardioembolic basilar artery occlusion.
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.
Smadja
Didier
D
Department of Neurology, University Hospital of Fort-de-France, Martinique, the French West Indies. didier.smadja@chu-fortdefrance.fr
Olindo
Stéphane
S
Saint-Vil
Martine
M
Chausson
Nicolas
N
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
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase