title: Glycoprotein IIb/IIIa Inhibitor Bridging and Subsequent Endovascular Therapy in Vertebrobasilar Occlusion in 120 Patients.
abstract: OBJECTIVE
  The treatment mode in acute vertebrobasilar occlusion (VBO) remains uncertain. We analyzed efficacy and safety of intravenous glycoprotein IIb/IIIa inhibitor (IV GPI) plus subsequent intra-arterial thrombolysis with or without additional endovascular mechanical therapy (percutaneous transluminal angioplasty/stenting or thrombus aspiration) and sought treatment factors that predict good clinical outcome.
  
  
  METHODS
  We retrospectively analyzed 120 cases of patients with angiographically proven acute VBO. Multivariate logistic regression was used to identify independent predictors for clinical outcome and included level of consciousness, age, sex, time to angiography, GPI agent, admission mode, occlusion type, recanalization success, and endovascular treatment mode. Clinical follow-up was dichotomized in no to moderate disability (modified Rankin scale (mRS) 0-3) vs. severe disability or death (mRS 4-6).
  
  
  RESULTS
  Median National Institutes of Health stroke scale (NIHSS) score on admission was 32, and mean NIHSS score was 24. A total of 49 patients (41 %) developed no to moderate disability (mRS 0-3), and 39 patients (33 %) died. Thrombolysis in myocardial infarction 2/3 recanalization success was achieved in 97 patients (80.8 %). Symptomatic intracerebral hemorrhages occurred in 11 patients (9 %). Mild impairment of consciousness (p < 0.001) and embolic occlusion type (p = 0.01) were significant predictors of favorable outcome. Clinical outcome in recanalized patients was better, but not statistically significant (p = 0.055).
  
  
  CONCLUSIONS
  Our results indicate that combined therapy with IV GPI and subsequent endovascular therapy may be a valid treatment strategy in acute VBO. With this treatment approach, a preserved vigilance before treatment and an embolic occlusion type are associated with no to moderate disability.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Haus Ost 22 (O 22), Martinistr. 52, 20246, Hamburg, Germany. m.ernst@uke.de.
authors.forename: M
authors.initials: M
authors.lastname: Ernst
authors.affiliation: Department of Neurology, Hospital Buchholz, Buchholz in der Nordheide, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Butscheid
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Haus Ost 22 (O 22), Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Fiehler
authors.affiliation: Radiological Office Buchholz, Buchholz in der Nordheide, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Wittkugel
authors.affiliation: Department of Neuroradiology, Helios Klinik Schwerin, Schwerin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Alfke
authors.affiliation: Department of Neuroradiology, University Medical Center Kiel, Kiel, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Jansen
authors.affiliation: Department of Neuroradiology, University Medical Center Luebeck, Luebeck, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Petersen
authors.affiliation: Department of Neuroradiology, University Medical Center Luebeck, Luebeck, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Koch
authors.affiliation: Department of Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Eckert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D039661:Integrin beta3 / Q000187:drug effects; D008297:Male; D061185:Mechanical Thrombolysis / Q000401:mortality*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D040201:Platelet Membrane Glycoprotein IIb / Q000187:drug effects; D011292:Premedication / Q000379:methods / Q000401:mortality; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*
chemical_list: D039661:Integrin beta3; D010975:Platelet Aggregation Inhibitors; D040201:Platelet Membrane Glycoprotein IIb
keywords: Acute stroke; GP-IIb/IIIa inhibitor; Intracerebral hemorrhage; Mechanical recanalization; Stents; Thrombolysis; Vertrobrobasilary disease