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Strokes attributable to basilar artery occlusion are fortunately uncommon but have a high risk of death or severe disability. Presentation is highly variable, and initial misdiagnosis by nonspecialists of patients with warning or progressive symptoms is common. Sometimes patients present at a late stage where intervention is unlikely to be successful. Hence, management of these patients is particularly challenging to vascular neurologists and stroke physicians.What do we know about basilar artery occlusion? As in anterior circulation ischemic strokes, “time is brain” and outcome depends on time to treatment, clinical state at presentation and whether and how quickly recanalization occurs. Without recanalization good recovery virtually never occurs. The rarity of basilar artery occlusion is reflected by the paucity of randomized controlled trials. One small randomized controlled trial of intra-arterial urokinase against anticoagulation in 16 patients with posterior circulation stroke suggested intra-arterial urokinase was associated with a better outcome.1 However, the main evidence base available to decide on the …

Intra-Arterial Thrombolysis Is the Treatment of Choice for Basilar Thrombosis