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Treating basilar artery occlusion.

Intravenous thrombolysis is as good as, if not better than, the recommended intraarterial approach for basilar artery occlusion, according to Perttu J. Lindsberg. M.D., and associates at Helsinki (Finland) University Central Hospital.

Several research groups have advocated the endovascular administration of thrombolytic agents directly to the posterior circulation in patients with basilar artery occlusion, and many medical centers have adopted this approach, even though there are no data comparing it with the less invasive intravenous approach.

The endovascular route requires a neuroradiologic interventionist and takes longer to set up and perform. Because this led to "unacceptable delays" in treatment at their hospital. Dr. Lindsberg and associates switched to using immediate intravenous recombinant tissue plasminogen activator (rTPA) in 50 consecutive patients with angiographically proven basilar artery occlusion between 1995 and 2003 (JAMA 2004;292:1862-6).

Complete or partial recanalization was achieved in 26 patients (52%). At 3 months, 20 patients had died, for an overall case fatality rate of 40%, and the likelihood of a good functional outcome was 24%. These are "the highest rates of survival and good outcome in basilar artery occlusion published so far," and compare favorably with 60% and 67% case-fatality rates reported with invasive endovascular thrombolysis.
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Author:Moon, Mary Ann
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:4EUFI
Date:Dec 1, 2004
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