Prolonged Low-Dose Intravenous Thrombolysis in a Stroke Patient With Distal Basilar Thrombus

Veltkamp, Roland; Jacobi, Christian; Kress, Bodo; Hacke, Werner

doi:10.1161/01.str.0000195171.29940.79

Cited by 7 publications

(3 citation statements)

References 8 publications

(4 reference statements)

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“…The higher frequency of vertebrobasilar occlusions or stenoses in the posterior ischemia group shown by the proposed method confirms earlier results, 2 which correlated vertebrobasilar vessel lesions with posterior stroke incidence. However, in concordance with other studies, 3,4 inborn variants of the vertebrobasilar anatomy detected by TrueFISP did not predispose to posterior ischemia.…”

Section: Discussionsupporting

confidence: 92%

MRI-Based Separation of Congenital and Acquired Vertebrobasilar Artery Anomalies in Ischemic Stroke of the Posterior Circulation

Freund

Kassubek

Aschoff

et al. 2008

Stroke

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Background and Purpose-Stroke MRI protocols provide useful information about underlying vessel pathologies in the anterior circulation by means of intracranial time-of-flight angiography. However, these protocols mostly fail in the posterior circulation to differentiate between congenital variants and secondary thrombosis. Therefore, a high-resolution anatomic True Fast Imaging in Steady State Precession sequence, added to a commonly used stroke imaging protocol, was evaluated. Methods-MRIs

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Section: Discussionsupporting

confidence: 92%

MRI-Based Separation of Congenital and Acquired Vertebrobasilar Artery Anomalies in Ischemic Stroke of the Posterior Circulation

Freund

Kassubek

Aschoff

et al. 2008

Stroke

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“…The use of prolonged low-dose IVT in AIS is reported sporadically, and the results of a large randomized study are not available. The available data indicate a relatively good safety profile and efficacy of this treatment (4,5). Acute ECIC bypass in very well-selected patients with ICA occlusion improves the chance of a good clinical outcome (6).…”

Section: Et Al Report Early Stent Restenosis In 19% Of Cases In Ais (...mentioning

confidence: 99%

Case report: Combined acute revascularization in early bilateral carotid stent occlusion

Černík

Bartoš²,

Neradová

et al. 2022

Front. Neurol.

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IntroductionThe introduction of a carotid stent involves the use of effective antiplatelet therapy to maintain stent patency. We present a case report of combined acute revascularization in a patient with occlusion in recently introduced stents of both carotid arteries.MethodsThe patient (male, 73 years) was admitted for stroke recurrence upon discontinuation of antiplatelet therapy. According to the CTA, the closure of implanted stents of both carotid arteries was confirmed. Intravenous thrombolysis and mechanical thrombectomy were performed with complete recanalization of the left carotid stent. At 3 days apart, clinical deterioration was found with progressive stent restenosis. Percutaneous transluminal stent angioplasty, mechanical embolectomy and prolonged low-dose intravenous thrombolysis have been used repeatedly.ResultsWith the impossibility of maintaining the patency of carotid stents even on the maximum drug therapy and despite endovascular procedures, bilateral neurosurgical revascularization of the middle cerebral arteries using ECIC bypasses was successfully performed. Prolonged low-dose intravenous thrombolysis (20 mg recombinant plasminogen aktivator (rTPA)/10 h) has proven to be an acute bridging therapy until surgery.ConclusionEarly occlusion of the carotid stent is a significant complication of endovascular treatment of stenotic arteries. ECIC bypass revascularization of the middle cerebral artery can be a highly effective therapeutic procedure.

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“…There also exists a case report of a patient with basilar artery stenosis prior to distal BAO treated 3 days after symptoms (vertical gaze palsy, spontaneous nystagmus, and gait ataxia) onset with low-dose IV administration of 0.125 mg/kg rt-PA that was continuously infused for 48 h resulting in favorable clinical outcome (mRS 0) (ref. 26 ).…”

Section: Intravenous Thrombolysismentioning

confidence: 99%

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

Dorňák

Herzig²,

Šaňák³

et al. 2014

BIOMED PAP

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Background. Acute basilar artery occlusion (BAO) is relatively infrequent form of acute ischemic stroke associated with severe and persisting neurological deficit and high mortality rate (to 86%). Early recanalization is essential for good clinical outcome but the most effective treatment approach remains unestablished. Several treatment strategies are currently available but their safety and efficacy have only been tested in retrospective/prospective case series. Randomized controlled trials (RCTs) are lacking. Methods and Results. We searched the PubMed database for assessments of recanalization rate and clinical outcome in BAO patients treated with various treatment methods. The results show that antithrombotics are least effective while specific reperfusion therapies including intravenous thrombolysis (IVT) and various types of intra-arterial therapy (IAT) are more so. Less than half of BAO patients reach independent outcome following IVT with a recanalization rate 52 -78%. Even though IAT recanalizes BAO more frequently (in up to 100%), the higher recanalization rate is not necessarily associated with better outcome. Conclusions. Good clinical outcome is strongly dependent on recanalization time. Thus, the concept of bridging therapy, combining widely available IVT with IAT, was introduced and is usually considered a rescue strategy in nonresponders to IV alteplase. A trend to better outcome in patients treated with bridging therapy in some studies, has to be confirmed by large RCTs.

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Prolonged Low-Dose Intravenous Thrombolysis in a Stroke Patient With Distal Basilar Thrombus

Cited by 7 publications

References 8 publications

MRI-Based Separation of Congenital and Acquired Vertebrobasilar Artery Anomalies in Ischemic Stroke of the Posterior Circulation

MRI-Based Separation of Congenital and Acquired Vertebrobasilar Artery Anomalies in Ischemic Stroke of the Posterior Circulation

Case report: Combined acute revascularization in early bilateral carotid stent occlusion

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

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