What is the role of intra-arterial thrombolysis in the treatment of basilar artery thrombosis?

Updated: Jan 11, 2019
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

This has emerged as a therapeutic strategy despite the absence of randomized, controlled clinical trials examining its use in vertebrobasilar occlusion.

Several case series have been published on intra-arterial thrombolysis, with the average time to treatment ranging from 8-48 hours. Overall mortality rates have decreased from 46-75% to 26-60%.

The rate of hemorrhagic transformation is approximately 8%, which is a little higher than that for IV thrombolysis in anterior circulation, confirmed by a study in animal models. Indeed, a systematic analysis demonstrated that the morbidity and mortality of patients treated with intra-arterial thrombolysis are not all that different from those associated with IV thrombolysis, although recanalization was achieved more frequently with intra-arterial thrombolysis. [17]

The patient's condition at presentation appears to be the major prognostic factor for intra-arterial thrombolysis; patients with quadriplegia and/or coma have worse outcomes than do other patients.

Ideally, patients with basilar artery occlusion should be treated within the context of a randomized trial. In the absence of this option, many stroke experts would advocate the use of embolectomy or intra-arterial thrombolysis. This decision, however, should be made with knowledge of the background information described below and with recognition of the absence of evidence from randomized trials.


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