Long-term Outcome After Intravenous Thrombolysis of Basilar Artery Occlusion

Lindsberg, Perttu J.; Soinne, Lauri; Tatlısumak, Turgut; Roine, Risto O.; Kallela, Mikko; Häppölä, Olli; Kaste, Markku

doi:10.1001/jama.292.15.1862

Cited by 185 publications

(169 citation statements)

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“…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.…”

mentioning

confidence: 99%

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

Cho¹,

Nighoghossian²,

Tahon³

et al. 2008

AJNR Am J Neuroradiol

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mentioning

confidence: 99%

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

Cho¹,

Nighoghossian²,

Tahon³

et al. 2008

AJNR Am J Neuroradiol

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“…The absence of well-balanced comparative studies of the literature-based outcomes or a large prospective randomized trial has led to a different view on the preferred therapy, that is, IVT or IAT. Lindsberg et al 17 reported a 52% recanalization rate after IV rtPA in patients with BAO. However, several series have reported rates of recanalization with IAT that were thought to be higher than that for IVT 4,[14][15][16] .…”

Section: Discussionmentioning

confidence: 98%

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

Yun

Kwak²,

Hwang³

et al. 2011

Interv Neuroradiol

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Mechanical clot disruption for the treatment of acute basilar artery occlusion (BAO) is known to provide a benefit. We aimed to determine the safety, recanalization rate and time-to-flow restoration of mechanical clot disruption and low dose urokinase (UK) infusions for the treatment of patients with acute BAO. Between June 2006 and June 2010, 21 patients with acute BAO underwent endovascular treatment that included angioplasty or stent placement. The time to treatment, duration of the procedure, dose of urokinase (UK), recanalization rates and symptomatic hemorrhages were analyzed. Clinical outcome measures were assessed at admission and at the time of discharge using the National Institutes of Health Stroke Scale (NIHSS) score and at three months after treatment using the modified Rankin Score (mRS). On admission, the median NIHSS score was 13.2. Median time from symptom onset to arrival at hospital was 356 minutes, and median time from symptom onset to intraarterial thrombolysis (IAT) was 49 minutes. We used the following interventional treatment regimens: Intraarterial (IA) UK and a minimal mechanical procedure (n=14), IA UK with angioplasty (n=1), IA UK with angioplasty and stent placement (n=3) and IA UK with HyperForm (n=3). The recanalization (thrombolysis in cerebral ischemia grade II or III) rate was 90.5% (19/21). There was symptomatic hemorrhage in one patient (4.8%). The median NIHSS score at discharge was 6.3. The three-month outcome was favorable (mRS: 0–2) for 14 patients (66.7%) and poor (mRS: 3–6) for seven patients (33.3%). The overall mortality at three months was 14.3% (three patients died). Low-dose IAT with mechanical clot disruption is a safe and effective treatment for treatment for acute BAO.

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“…Las oclusiones de la arteria basilar, de muy mal pronóstico, clásicamente eran tratadas con abordaje intraarterial; sin embargo, hay estudios que muestran un beneficio de la trombolisis intravenosa, tanto en las tres primeras horas como en las siguientes. Lindsberg y col concluyen en sus trabajos 36,37 que en estos casos el rTPA iv tiene unas cifras de supervivencia, recanalización y evolución funcional independiente comparables con los resultados de técnicas endovasculares. Las ventanas terapéuticas utilizadas por este grupo son de hasta 24-48 horas sugiriendo que, además de que son pacientes cuyo pronóstico ominoso sin tratamiento fuerza a los profesionales a individualizar sus decisiones, hay datos para hipotetizar que la resistencia del tejido a la oclusión de estas arterias y al tiempo en penumbra isquémica puede ser mayor 38 , probablemente debido a los patrones de circulación colateral que se desarrollan.…”

Section: Expansión De La Ventana Terapéutica: Más Allá De Las 3 Horasunclassified

Reperfusión en el ictus isquémico agudo: estado actual y futuro

Herrera

Gállego

Muñóz

et al. 2008

Anales Sis San Navarra

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RESUMENLa isquemia cerebral es un proceso dinámico desencadenado al ocluirse una arteria intracraneal de forma aguda, habitualmente por un embolismo, desde el corazón o desde lesiones arterioescleróticas de arterias más proximales. La recanalización urgente de dichas arterias y reperfusión precoz del tejido cerebral, las terapias neuroprotectoras que intervengan en la cascada isquémica y la prevención de la recurrencia son los objetivos terapéuticos en la fase aguda del ictus isquémico. El tratamiento trombolítico persigue la lisis del coágulo que ocluye la arteria intracraneal. En la actualidad, el único aprobado es el activador tisular del plasminógeno (rtPA) por vía intravenosa. Se ha demostrado su seguridad y eficacia dentro de las tres primeras horas de evolución del ictus isquémico. La instauración de este tratamiento implica una profunda modificación de las estructuras sanitarias y entrenamiento del personal responsable. La pequeña ventana terapéutica y las limitaciones que este fármaco tiene en la práctica diaria han urgido a abrir caminos para explorar nuevas estrategias: se revisan la reconsideración de los criterios de exclusión (especialmente en ancianos y déficits neurológicos menores o de rápida mejoría), la expansión de la ventana terapéutica mas allá de las 3 horas con selección de pacientes por imagen multimodal, la posibilidad de trombolisis combinada con fármacos antitrombóticos o con potenciación por ultrasonidos. Se revisan asimismo nuevos trombolíticos que van surgiendo y el abordaje intraarterial trombolisis intraarterial y terapias de reperfusión endovascular mecánica.Palabras clave. Reperfusión. Ictus agudo. Trombolisis. Recanalización. ABSTRACTCerebral ischaemia is a dynamic process triggered when an intracraneal artery is acutely occluded, normally due to an embolism from the heart or from arteriolosclerotic lesions of more proximal arteries. Urgent rerouting of these arteries and early reperfusion of the cerebral tissue, neuroprotector therapies that intervene in the ischaemic cascade and prevention of recurrence are the therapeutic aims in the acute phase of ischaemic stroke. Thrombolytic treatment pursues the lysis of the dot occluding the intracranial artery. At present, the only approved thrombolytic treatment is the intravenous Recombinant Tissue Plasminogen Activator (rtPA). Its safety and efficacy within the first three hours of evolution of the ischaemic stroke have been demonstrated. Establishment of this treatment involves a profound change in the health structures and the training of the personnel responsible. The small therapeutic window and the limitations of this medicine in daily practice have led to the urgent exploration of new strategies: we review the reconsideration of exclusion criteria (especially in the elderly and in minor neurological deficits or those of rapid improvement), the widening of the therapeutic window beyond 3 hours with the selection of patients by multimodal image, the possibility of thrombolysis combined with antithrombotic drugs or with enhance...

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Long-term Outcome After Intravenous Thrombolysis of Basilar Artery Occlusion

Cited by 185 publications

References 14 publications

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

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

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

Reperfusión en el ictus isquémico agudo: estado actual y futuro

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