Stroke or Transient Ischemic Attacks With Basilar Artery Stenosis or Occlusion

Devuyst, G.; Bogousslavsky, Julien; Meuli, Reto; Moncayo, Jorge; Freitas, Gabriel; Melle, G. Van

doi:10.1001/archneur.59.4.567

Cited by 91 publications

(61 citation statements)

References 34 publications

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“…This patient had a poor prognosis, based on her dysarthria, impaired consciousness and severe paresis as a result of basilar artery territory ischemia (28). As the best treatment for arterial dissection remains uncertain, we first administered intravenous rt-PA.…”

Section: Discussionmentioning

confidence: 99%

Thrombectomy using Trevo ProVue Stent Retriever Devices after Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Basilar Artery Occlusion during Vertebral Artery Dissection

et al. 2016

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A 41-year-old woman was admitted due to a sudden-onset severe headache, left hemiparesis and dysarthria. Diffusion-weighted magnetic resonance imaging showed an acute infarct in the bilateral pons, and magnetic resonance angiography revealed basilar artery (BA) occlusion resulting from dissection of the right vertebral artery (VA). She was treated with intravenous recombinant tissue plasminogen activator (rt-PA) 110 minutes after symptom onset. Subsequently, brain angiography was performed along with mechanical thrombolysis using Trevo ProVue retriever devices. The BA was successfully recanalized 240 minutes after the onset of symptoms. Thrombectomy is a promising treatment strategy for cases of VA dissection resistant to intravenous rt-PA thrombolysis.

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Section: Discussionmentioning

confidence: 99%

Thrombectomy using Trevo ProVue Stent Retriever Devices after Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Basilar Artery Occlusion during Vertebral Artery Dissection

et al. 2016

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“…Clinically, patients typically have impaired consciousness, oculomotor disturbances, diplopia, vertigo, dysarthria, cerebellar ataxia and often bilateral motor deficits including Babinski's signs. Headache has been reported to occur in about 25% of cases but it is neither the major nor the leading symptom [2]. Early diagnosis is mandatory to apply modern therapeutic methods such as systemic or local fibrinolysis with rtPA, treatment with abciximab or interventional neuroradiological methods including local stenting [3].…”

Section: Discussionmentioning

confidence: 99%

Migraine-like headache as the presenting symptom of basilar artery occlusion

Heckmann¹,

Läng²,

Weber³

et al. 2003

J Headache Pain

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“…1,2,9,12 ). As all of these studies were too small to provide solid data, the sample of 82 patients presented by Schonewille et al provided more accurate data: mortality 40% and dependency among survivors 65% (ref.…”

Section: Nonspecific Treatmentmentioning

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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Stroke or Transient Ischemic Attacks With Basilar Artery Stenosis or Occlusion

Abstract: The prognosis of BAS greater than 50% or BAO is diverse and certain clinical characteristics seem to predict a lower risk of poor outcome. Their presence may help to decide the most suitable therapy.

Cited by 91 publications

References 34 publications

Thrombectomy using Trevo ProVue Stent Retriever Devices after Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Basilar Artery Occlusion during Vertebral Artery Dissection

Thrombectomy using Trevo ProVue Stent Retriever Devices after Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Basilar Artery Occlusion during Vertebral Artery Dissection

Migraine-like headache as the presenting symptom of basilar artery occlusion

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

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