Basilar artery thrombosis

Abstract

Basilar artery thrombosis is an infrequent but important neurological emergency requiring early diagnosis and treatment. Of particular relevance to emergency medicine is the recognition and consideration of the unusual signs that may be present in an often previously well patient. It is therefore crucial to expedite investigations, confirm the diagnosis and commence life‐saving treatment through the early involvement of a number of disciplines including neurology, radiology and intensive care. This paper confirms the use of magnetic resonance imaging and angiography as the preferred investigative mode and microcatheter directed intra‐arterial thrombolysis as the treatment strategy of choice.

Long-term Outcome After Intravenous Thrombolysis of Basilar Artery Occlusion

“…A 3-month outcome follow-up was performed for survivors by a stroke neurologist and a study nurse. It included the modified Rankin scale (mRS): no or minimal symptoms (0-1), mild to moderate disability (2-3), severely disabled or bedridden (4-5), dead (6); and the Barthel Index score: functional independence (95-100), moderate dependency (90-55), full dependency (50-0). For patients institutionalized or still in a rehabilitation hospital, scoring was performed by the treating physician and the nurse, determined from patient records, or by contacting the patient or relatives.…”

“…Previous reports 3,4,6,7 have advocated thrombolytic therapy delivered with an invasive endovascular approach to the occlusion site of the posterior circulation, but even short delays in therapy onset have been reported to be the single most critical factor affecting outcome. 5 We report the results of the first 50 consecutive patients with proven BAO treated according to our institutional protocol.…”

Therapy of Basilar Artery Occlusion

“…Lack of well-balanced comparison of literaturebased outcome descriptions or a large randomized trial has led to various views on the preferred therapy that are not based on comparative evidence. 22 Systemic thrombolysis has been linked with less frequent recanalization and more frequent hemorrhagic complications, 15 the latter having been recently supported by experiments in an animal model. 23 However, both IVT and endovascular recanalization techniques have advantages and disadvantages.…”

Options for Recanalization Therapy in Basilar Artery Occlusion

“…4,5,7 Several studies also found the delay in therapy onset to be a critical prognostic factor, apart from recanalization. 6,8 Introduction of an intra-arterial catheter to administer thrombolytics locally may at times be difficult and time-consuming, considering the often stenosed and elongated arteriosclerotic vertebral arteries, and can increase treatment delay if considered the sole therapy mode.…”