Browse by author
Lookup NU author(s): Professor Gary Ford
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
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 most effective treatment approach comprises retrospective and prospective patient cohorts from different centers using a variety of protocols. Most case series report experience of using intra-arterial thrombolysis rather than intravenous thrombolysis or anticoagulation. That the management of intra-arterial thrombolyisis is controversial is therefore not surprising, because interpretation of nonrandomized evidence is difficult, and "reasonable" people can draw different conclusions.
Author(s): Ford GA
Publication type: Editorial
Publication status: Published
Journal: Stroke
Year: 2006
Volume: 37
Issue: 9
Pages: 2438-2439
ISSN (print): 0039-2499
ISSN (electronic): 1524-4628
Publisher: Lippincott Williams & Wilkins
URL: http://dx.doi.org/10.1161/01.STR.0000237211.84743.d8
DOI: 10.1161/01.STR.0000237211.84743.d8
