title: Emergent stent placement following intra-arterial thrombolysis for the treatment of acute basilar artery occlusion.
abstract: Acute basilar artery occlusion (BAO) is a condition producing high rates of morbidity and mortality. Intravenous thrombolysis or intra-arterial thrombolysis are therapeutic options; however, the clinical outcomes remain poor. The purpose of the present study was to evaluate feasibility, safety, and efficacy of emergency stent placement following intra-arterial thrombolysis for patients with acute BAO. Thirty-six consecutive patients were treated for acute BAO using intra-arterial therapy from September 2004 to October 2009. Nine patients, with a Glasgow Coma Scale (GCS) score ranging from 8 to 12, underwent emergency stent placement following inadequate revascularization after thrombolysis. Neurological status prior to treatment was evaluated using the GCS score. Modified Rankin Scale (mRS) scores at 90 days post-treatment were used to assess functional outcome and we reviewed clinical records for frequency of procedure-related complications. Stents were deployed at the target lesion in all patients. Successful revascularization was achieved in eight of nine (88.9%) patients (residual stenosis <50%). The median GCS score prior to thrombolysis was 9 (range: 6-12) and prior to stent placement was 10 (range: 8-12). Four patients (44.4%) achieved good outcomes as determined by the mRS scale (0-2 at 90 days). Mortality was 33.3% in all procedures with one patient (11.1%) experiencing acute intrastent thrombus formation. No patient developed symptomatic intracerebral hemorrhage. Data from our small case series demonstrates that emergency stent placement following intra-arterial thrombolysis is a feasible treatment for patients with acute BAO and may reduce mortality and prevent re-occlusion of the basilar artery.
authors.affiliation: Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, 71 Xinmin Street, Changchun 130021, China.
authors.forename: MingChao
authors.initials: M
authors.lastname: Shi
authors.forename: ShouChun
authors.initials: S
authors.lastname: Wang
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.forename: JiaChun
authors.initials: J
authors.lastname: Feng
authors.forename: Jiang
authors.initials: J
authors.lastname: Wu
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects / Q000592:standards; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014715:Vertebrobasilar Insufficiency / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator