Current treatment of basilar artery occlusion
Article first published online: 20 SEP 2012
© 2012 New York Academy of Sciences.
Annals of the New York Academy of Sciences
Volume 1268, Thrombolysis and Acute Stroke Treatment pages 35–44, September 2012
How to Cite
Lindsberg, P. J., Sairanen, T., Strbian, D. and Kaste, M. (2012), Current treatment of basilar artery occlusion. Annals of the New York Academy of Sciences, 1268: 35–44. doi: 10.1111/j.1749-6632.2012.06687.x
- Issue published online: 20 SEP 2012
- Article first published online: 20 SEP 2012
- basilar occlusion;
- mechanical thrombectomy;
- acute stroke care
Basilar artery occlusion (BAO) is associated with high mortality (85–95%) if recanalization does not occur. Evidence of the efficacy of different therapy protocols of intravenous thrombolysis (IVT) or intraarterial thrombolysis (IAT) and/or mechanical endovascular treatment is based on retrospective or prospective patient cohorts, since randomized controlled trials (RCTs) do not exist. Roughly a third of BAO patients reach independent outcome following thrombolysis. From those in whom recanalization occurs, about half will reach independence. In noninvasive and endovascular protocols, recanalization of BAO is reached in 60–85% of the patients. While invasive endovascular approaches afford greater recanalization rates, they have not been proven superior to IVT in terms of functional outcome. Meaningful survival after BAO requires rapid access to thrombolysis. “Bridging” protocols have been introduced where rescue therapies such as endovascular thrombolysis and on-demand mechanical thrombectomy or angioplasty are used. Multimodal imaging techniques should be used to choose the best therapeutic option individually.