title: Current treatment of basilar artery occlusion.
abstract: Basilar artery occlusion (BAO) is associated with high mortality (85-95%) if recanalization does not occur. Evidence of the efficacy of different therapy protocols of intravenous thrombolysis (IVT) or intraarterial thrombolysis (IAT) and/or mechanical endovascular treatment is based on retrospective or prospective patient cohorts, since randomized controlled trials (RCTs) do not exist. Roughly a third of BAO patients reach independent outcome following thrombolysis. From those in whom recanalization occurs, about half will reach independence. In noninvasive and endovascular protocols, recanalization of BAO is reached in 60-85% of the patients. While invasive endovascular approaches afford greater recanalization rates, they have not been proven superior to IVT in terms of functional outcome. Meaningful survival after BAO requires rapid access to thrombolysis. "Bridging" protocols have been introduced where rescue therapies such as endovascular thrombolysis and on-demand mechanical thrombectomy or angioplasty are used. Multimodal imaging techniques should be used to choose the best therapeutic option individually.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. perttu.lindsberg@hus.fi
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
authors.forename: Tiina
authors.initials: T
authors.lastname: Sairanen
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
mesh_terms: D000465:Algorithms; D002548:Cerebral Revascularization / Q000379:methods; D015331:Cohort Studies; D000075202:Contraindications; D003937:Diagnosis, Differential; D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006757:Hospital Units; D006801:Humans; D059906:Neuroimaging / Q000379:methods; D018579:Patient Selection; D010641:Phenotype; D011379:Prognosis; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery
chemical_list: D005343:Fibrinolytic Agents