Long-Term Follow-Up of Patients after Intraarterial Thrombolytic Therapy of Acute Vertebrobasilar Artery Occlusion

Abstract

Local thrombolysis may reduce mortality after acute vertebrobasilar artery occlusion. We focused on variables affecting recanalization, outcome and long-term prognosis. Thirty-six patients with vertebrobasilar artery occlusion were treated with local intraarterial thrombolytic therapy. Four of the survivors were among the 16 patients without recanalization. Recanalization was associated with a higher survival rate. Top-of-the-basilar-type occlusions have the highest recanalization rate. The thrombolytic medication used did not influence the recanalization frequency. One patient died due to an intracerebral bleed after thrombolysis. There was no association between the time interval (greater or less than 6 h) between the onset of symptoms and therapy initiation and survival. Relapses during follow-up (mean follow-up 3.7 years) did not occur. MRI/MRA and ultrasound studies during follow-up showed unchanged results in these patients. All survivors at the time of follow-up lived at home.

Brain Stem Diffusion-Weighted Imaging Lesion Score: A Potential Marker of Outcome in Acute Basilar Artery Occlusion

“…7,10 Recanalization was achieved in 22/29 (76%) patients, in line with previous studies using interventional approaches. [7][8][9][10]12 Although no significant association between recanalization and outcome was observed in our series, probably due to the small sample size, no patient with failed recanalization achieved functional independence.…”

“…4,5 Intraarterial thrombolysis (IAT) and percutaneous transluminal angioplasty/stent placement have decreased BAO mortality to 30%-65%. [6][7][8][9][10][11][12] Fewer data are available for intravenous thrombolysis (IVT), [13][14][15] but a recent meta-analysis showed no significant difference in outcome between IVT and IAT, despite higher recanalization rates with IAT. 11 To our knowledge, no randomized study comparing IVT and IAT is available.…”

Therapy of Basilar Artery Occlusion

“…4,9,[11][12][13]17,18,24 This systematic review adds to our knowledge on prognosis of BAO that once the decision to give thrombolytics has been made, their route of administration does not play a major role for clinical prognosis. This finding has important implications for the routine management of most patients with BAO.…”

“…Rather than depending on the route of administration of thrombolytics, the rates of recanalization are influenced by the occluded segment of the basilar artery; the distal, typically embolic occlusions 7,8 recanalize more easily than the more proximal ones. 9,[11][12][13]18,24 In addition, 2 recent studies suggest that recanalization is also more likely if thrombolysis can be started early. 12,13 Hemorrhagic complications were slightly but not significantly more frequent after IVT (11%) than after IAT (8%; Pϭ0.59).…”

Endovascular Management in Patients with Acute Basilar Artery Obstruction: Low-Dose Intra-Arterial Urokinase and Mechanical Clot Disruption

“…The patients with distal migration of thrombus into the posgies are cardiac emboli and vertebral artery dissections. The outcome of acute BAO depends on the clinical state at presentation, the length and location of the occlusion, the degree of recanalization and the time to treatment 2,3,[8][9][10][11][12][13] . For BAO, early recanalization is known to be one of the most important factors for a good outcome [8][9][10] .…”