Document Detail


Long-term outcome after intravenous thrombolysis of basilar artery occlusion.
MedLine Citation:
PMID:  15494584     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Basilar artery occlusion (BAO) is an infrequent disease with high morbidity and mortality. Intra-arterial thrombolysis is advocated for treatment but is limited to use at specialized centers.
OBJECTIVE: To evaluate outcomes for patients with BAO treated with intravenous thrombolytic therapy.
DESIGN, SETTING, AND PARTICIPANTS: During 1995 to 2003, 50 consecutive patients with angiographically proven BAO were treated according to an institutional therapy protocol based on intravenous thrombolysis with recombinant tissue plasminogen activator (alteplase). Patients were treated at an urban university teaching hospital receiving all patients with ischemic stroke who were considered for thrombolysis in a catchment area of 1.5 million inhabitants in Helsinki, Finland.
INTERVENTION: Intravenous administration of alteplase (0.9 mg/kg) during a 1-hour infusion.
MAIN OUTCOME MEASURES: Basilar artery recanalization determined by magnetic resonance angiography and clinical outcomes at 3 months and at 1 year or longer determined by modified Rankin Scale and Barthel Index scores.
RESULTS: Recanalization was studied in 43 patients and verified in 26 (52%) of all patients. By 3 months, 20 patients (40%) had died while 11 had good outcomes (modified Rankin Scale score, 0-2); 12 (24%) reached independence in activities of daily living (Barthel Index score, 95-100), and 6 (16%) were severely disabled (Barthel Index score, 0-50). In the long term (median follow-up 2.8 years), 15 patients (30%) reached good outcomes (modified Rankin Scale score, 0-2) while 23 (46%) died.
CONCLUSIONS: Intravenous administration of alteplase for patients with BAO appears to be associated with rates of survival, recanalization, and independent functional outcome comparable with those reported with endovascular approaches. These data suggest that a randomized trial is needed to compare these approaches for treatment of BAO.
Authors:
Perttu J Lindsberg; Lauri Soinne; Turgut Tatlisumak; Risto O Roine; Mikko Kallela; Olli Häppölä; Markku Kaste
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JAMA     Volume:  292     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-20     Completed Date:  2004-10-22     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1862-6     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Female
Fibrinolytic Agents / therapeutic use*
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Quality of Life
Thrombolytic Therapy*
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome
Vertebrobasilar Insufficiency / diagnosis,  drug therapy*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Comment In:
JAMA. 2004 Oct 20;292(15):1883-5   [PMID:  15494587 ]

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