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Current treatment of basilar artery occlusion
Author(s) -
Lindsberg Perttu J.,
Sairanen Tiina,
Strbian Daniel,
Kaste Markku
Publication year - 2012
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.2012.06687.x
Subject(s) - thrombolysis , medicine , angioplasty , randomized controlled trial , basilar artery , occlusion , endovascular treatment , balloon , surgery , radiology , myocardial infarction , aneurysm
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.