Local Thrombolytic Therapy in Acute Basilar Artery Occlusion: Experience with 18 Patients

Möbius, E.; Berg-Dammer, E.; Kühne, D.; Nahser, H. C.

doi:10.1007/978-3-642-76439-4_25

Cited by 28 publications

(6 citation statements)

References 3 publications

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“…2 Since then further reports have shown the clinical benefit of this approach. [3][4][5][6][7] We report, retrospectively, 16 patients who had acute occlusion of the basilar artery between 1985 and 1993 and who were treated by intravenous fibrinolysis. Patients and methods Twenty two patients with acute occlusion of the basilar artery were retrospectively investigated between 1985 and 1993.…”

mentioning

confidence: 99%

Thrombolytic treatment for acute occlusion of the basilar artery.

Huemer

Niederwieser

Ladurner

1995

Journal of Neurology, Neurosurgery & Psychiatry

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mentioning

confidence: 99%

Thrombolytic treatment for acute occlusion of the basilar artery.

Huemer

Niederwieser

Ladurner

1995

Journal of Neurology, Neurosurgery & Psychiatry

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“…Since the 1980s, various case reports and follow-up studies on the outcome of acute vertebro-basilar thrombosis have been published [2,4,5,8,14]. The frequency of recanalisation after thrombolytic therapy has been estimated to be between 40 and 100%, and the survival rate between 25 and 70%, depending on patients selection and the type of therapy [2,4,5,8,[14][15][16]. Unfortunately, the number of patients available was often too low to draw valid conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…use of fibrinolytics in the early 1980s led to a significant improvement of prognosis. However, even after successful recanalisation of the basilar artery, mortality still reached an average of 50% [4][5][6]. This may have been due to the fact that vulnerable brain tissue in critical brain stem structures has been irreversibly damaged before initiation of sufficient therapy and vessel recanalisation.…”

Section: Introductionmentioning

confidence: 99%

Clinical Diagnostics, Therapy and Outcome After Basilar Artery Thrombosis

Lohse¹,

Preul²

2011

TOCCMJ

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Acute basilar artery occlusion is a relatively rare but life threatening condition requiring rapid diagnosis and treatment. The circumstances and predictive value for outcome in these patients are not well documented. 88 patients with basilar artery occlusion treated in the Department of Neurology at Jena University Hospital from 1998 to 2007 were identified and studied. Of these, 45 were males and 43 females, aged between 20 and 92 years (median, 63 years). In 60.2%, MRI with MR angiography led to the diagnosis; 13.6% of all cases were diagnosed by cranial CT. 45 patients were treated with thrombolytic therapy with rt-PA (44/45) or urokinase (1/45; in 1999). Out of 45 patients, eight (17.7%) initially received systemic (i.v.) thrombolytic treatment. Recent research has suggested that for patients with unambiguous basilar artery thrombosis, the only promising treatment option is early thrombolytic treatment. The major clinical goal is to enable patients to live an independent life after the acute phase and, if required, rehabilitation. Consequently, this challenges the concept of a "thrombolysis at all costs" approach, especially in case of multi-morbidity, unidentifiable time frames, and comatose patients with regards to possible poor functional prognosis. An adequate therapy in the sense of an adaptable scheme, starting with immediate maximum therapy following diagnosis, and with defined decision points for possible therapeutic limitations at later stages of the disease course after ensuring poor prognosis may require further testing, depending on clinical conditions and the patients' documented, or presumable wishes.

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“…221 Subsequent reports have supported recanalization efficacy with these agents. 186,222,223 However, significant hemorrhagic transformation also occurs in this setting. Current practice is approached on a case-by-case basis with the option for instrumentation in some.…”

Section: Direct Local Infusion Of Plasminogen Activatorsmentioning

confidence: 99%

Plasminogen Activators and Ischemic Stroke: Conditions for Acute Delivery

Zoppo

2013

Semin Thromb Hemost

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Appropriate acute treatment with plasminogen activators (PAs) can significantly increase the probability of minimal or no disability in selected ischemic stroke patients. There is a great deal of evidence showing that intravenous recombinant tissue PAs (rt-PA) infusion accomplishes this goal, recanalization with other PAs has also been demonstrated in the development of this treatment. Recanalization of symptomatic, documented carotid or vertebrobasilar arterial territory occlusions have also been achieved by local intra-arterial PA delivery, although only a single prospective double-blinded randomized placebo-controlled study has been reported. The increase in intracerebral hemorrhage with these agents by either delivery approach underscores the need for careful patient selection, dose-appropriate safety and efficacy, proper clinical trial design, and an understanding of the evolution of cerebral tissue injury due to focal ischemia. Principles underlying the evolution of focal ischemia have been expanded by experience with acute PA intervention. Several questions remain open that concern the manner in which PAs can be applied acutely in ischemic stroke and how injury development can be limited.

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Local Thrombolytic Therapy in Acute Basilar Artery Occlusion: Experience with 18 Patients

Cited by 28 publications

References 3 publications

Thrombolytic treatment for acute occlusion of the basilar artery.

Thrombolytic treatment for acute occlusion of the basilar artery.

Clinical Diagnostics, Therapy and Outcome After Basilar Artery Thrombosis

Plasminogen Activators and Ischemic Stroke: Conditions for Acute Delivery

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