Drip, ship, and retrieve: cooperative recanalization therapy in acute basilar artery occlusion.
OBJECTIVE
In acute basilar artery occlusion, intra-arterial thrombolysis or endovascular mechanical recanalization may result in higher recanalization rates than intravenous thrombolysis. However, many patients are admitted to community hospitals, where endovascular therapy is usually not readily available. We initiated a "drip, ship, and retrieve" cooperative treatment protocol in 2006, in which thrombolysis was initiated in the community hospital with simultaneous referral to our stroke center and the use of endovascular mechanical recanalization as required.


METHODS
The outcome of all consecutive patients treated by this protocol between 2006 and June 2009 was compared with that of a similar population of referred patients who had received primary intra-arterial therapy with or without tirofiban bridging at our center between 2003 and 2005.


RESULTS
In both groups, 26 patients were identified. The rate of symptomatic intracranial hemorrhage was 12% in previous patients and 8% in those treated under the new protocol. Recanalization rates were similar: 92% in previous patients and 85% with the new protocol; 38% of these had recanalization after intravenous thrombolysis alone. Functional outcome was better among those treated with the new protocol, with more patients achieving a modified Rankin scale score < or = 2 (38% versus 12%; P=0.03) and < or = 3 (50% versus 23%; P=0.04).


CONCLUSIONS
"Drip, ship, and retrieve" seems to be feasible and safe in acute basilar artery occlusion. Patients appear to benefit from initiation of intravenous thrombolysis in the community hospital before transfer. Randomized controlled trials will have to confirm the expected benefit of subsequent on-demand mechanical recanalization on clinical outcome.
Department of Neurology, Klinikum Grosshadern, University of Munich, Munich, Germany. Thomas.Pfefferkorn@med.uni-muenchen.de
Thomas
T
Pfefferkorn
Markus
M
Holtmannspötter
Caroline
C
Schmidt
Andreas
A
Bender
Hans-Walter
HW
Pfister
Andreas
A
Straube
Thomas E
TE
Mayer
Hartmut
H
Brückmann
Martin
M
Dichgans
Gunther
G
Fesl
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000473:pathology; D002985:Clinical Protocols; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents