Abstract
IntroductionWe investigated whether thrombus length measured in Computed Tomography Angiography (CTA) is predictive of the success rate of intravenous thrombolysis (IVT) in acute basilar occlusion and whether recanalization can be achieved by additional mechanical endovascular thrombectomy.MethodsIn 51 patients with acute basilar thrombosis thrombus length was measured on CTA images before intravenous thrombolysis (IVT) with rt-PA was started. After 114 minutes on average success of IVT was evaluated either by CTA or DSA. Patients with persistent basilar occlusion and no major brainstem infarction on CT underwent endovascular recanalization.Results87% of patients had no recanalization of basilar artery after IVT alone. The average thrombus length was 15 mm in patients with persistent basilar occlusion after IVT and 7 mm in patients with recanalization after IVT. Thrombi longer than 13 mm did not resolve after IVT alone and 80% of thrombi shorter than 13 mm did not resolve either. 41 patients were transferred to endovascular recanalization; endovascular therapy was performed successfully in 90% (37 / 41).ConclusionsRecanalization rates in acute basilar occlusion after IVT alone are low and dependent on thrombus length. Additional mechanical endovascular thrombectomy showed to be a very successful recanalization therapy.
Highlights
We investigated whether thrombus length measured in Computed Tomography Angiography (CTA) is predictive of the success rate of intravenous thrombolysis (IVT) in acute basilar occlusion and whether recanalization can be achieved by additional mechanical endovascular thrombectomy
Over the last two decades intravenous thrombolysis has been established as standard treatment for acute thrombotic occlusions of intracranial vessels [3, 4]
Intraarterial thrombolysis has shown to be effective in anterior circulation middle cerebral artery (MCA) vessel occlusions in acute stroke [5, 6]
Summary
In 51 patients with acute basilar thrombosis thrombus length was measured on CTA images before intravenous thrombolysis (IVT) with rt-PA was started. In the retrospective analysis of our patient data from 2 university hospitals we identified 68 patients who were treated at our institutions between 2005 and 2013 and between 2016 and 2017 for acute basilar thrombosis. 1. with complete occlusion of the basilar artery (BA) as proven by CT angiography (CTA) before start of intravenous thrombolysis, and. 2. who received intravenous thrombolysis with rt-PA for this condition. 3. with insufficient quality of CTA owing to motion artifacts or insufficient imaging protocols not allowing thrombus length measurements. Our diagnostic algorithm for suspected basilar thrombosis includes multislice CT with both non-enhanced computed tomography (NECT) scans of the brain and following arterial phase CTA from the aortic arch upwards with acquisition of thin slices (Slice Thickness 1 or 0.6 mm).
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