What is the role of thrombolytic therapy in the treatment of vertebrobasilar stroke?

Updated: Mar 03, 2020
  • Author: Vladimir Kaye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

In 1996, The US Food and Drug Administration (FDA) approved tissue plasminogen activator (tPA) for the treatment of acute ischemic stroke within the first 3 hours of onset. [14] Approval was based on data from the National Institute of Neurological Disorders and Stroke trial, which showed that a higher number of treated versus untreated patients had minimal deficit and minimal or no disability.

However, this trial did not include patients in stupor or coma, and that criterion probably excluded patients who suffered a basilar artery occlusion. Moreover, the trial did not study the vascular anatomy systematically in all patients. From experimental evidence and thrombolytic trials, it is apparent that recanalization improves outcome. [7, 30, 31]

In 2009, the American Heart Association/American Stroke Association (AHA/ASA) published a science advisory recommending that the time window for tPA administration be increased to 4.5 hours after a stroke, although this change has not been approved by the FDA. [32] Research indicates that tPA is effective in patients even when administered within the 3- to 4.5-hour window, [33, 34, 35] but the AHA/ASA stated that, despite its recommendation, the effectiveness of tPA administration in comparison with other treatments for thrombosis, within that time period, is not yet known.


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