title: Prolonged low-dose thrombolysis in posterior circulation stroke.
abstract: BACKGROUND
  We aimed to investigate the feasibility, preliminary safety, and efficacy of prolonged low-dose intravenous thrombolysis in posterior circulation stroke patients with a thrombus lodged in the basilar artery who were ineligible for standard rtPA administration.
  
  
  METHODS
  We retrospectively analyzed consecutively collected patients in our stroke database who suffered from a basilar artery thrombosis and were treated with prolonged (>1 h), intravenous, low-dose (≤20 mg) rtPA between 01/2005 and 11/2012.
  
  
  RESULTS
  Patients included in this study (n = 14) were 68.5 years (IQR 55.5; 72.75) of age and presented with a median NIHSS of 2 (1; 5.25). Median time from symptom onset to treatment was 63 h (33; 141). A median dose of 5.21 μg/kg h (4.46; 6.25) rtPA was administered over 24 h (min 10; max 48). No patient experienced symptomatic intracerebral hemorrhage, one patient developed a spinal epidural hematoma, and two elderly patients were switched to comfort care and died. In eight patients (57%) a decrease in thrombus size or no thrombus at all was detected on control imaging. Nine patients (64%) had a favorable outcome (mRS 0-2) at day 90.
  
  
  CONCLUSIONS
  Prolonged low-dose thrombolysis with rtPA may be considered as individual treatment option in selected high-risk patients with basilar artery thrombosis. Presented data may lay the groundwork to further investigate safety and efficacy in a prospective trial.
authors.affiliation: Department of Neurology, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany, Christian.Hametner@med.uni-heidelberg.de.
authors.forename: C
authors.initials: C
authors.lastname: Hametner
authors.forename: L
authors.initials: L
authors.lastname: Kellert
authors.forename: R
authors.initials: R
authors.lastname: Veltkamp
authors.forename: L
authors.initials: L
authors.lastname: Behrens
authors.forename: S
authors.initials: S
authors.lastname: Nagel
authors.forename: W
authors.initials: W
authors.lastname: Hacke
authors.forename: P
authors.initials: P
authors.lastname: Ringleb
mesh_terms: D000368:Aged; D001488:Basilar Artery / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000188:drug therapy*; D020767:Intracranial Thrombosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator