Do patients with acute vertebrobasilar occlusion benefit from an aggressive treatment strategy?
Rüdiger von Kummer
Correspondence University Hospital, Fetscherstrasse 74, 01307 Dresden, Germany
Email ruediger.vonkummer@uniklinikum-dresden.de
This article has no abstract so we have provided the first paragraph of the full text.
Brain stem strokes that are caused by basilar artery or bilateral vertebral artery occlusion are relatively rare, but fatal in most instances if recanalization cannot be achieved in time. To my knowledge, the first case report on successful recanalization of the basilar artery with intravenous urokinase therapy and full clinical recovery was published in 1981,1 and since then only 5 other case series of 40 or more patients have been published, including a total of 267 patients.2, 3, 4, 5, 6 Patients with such catastrophic disease can appear in larger stroke centers every 2 months, on average. The diagnosis can be missed in some patients, however, because symptoms can be unspecific and be mistaken for intoxication or metabolic coma, in which case no angiography is performed. This explains why experience in this condition—the worst type of stroke—is limited. The published data suggest that clinical outcome in these patients is associated with many factors: neurologic deficit at baseline, recanalization, time of intervention, length and type of basilar artery obstruction (i.e. embolic versus atherosclerotic) and the capacity of collateral circulation.
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