Acute basilar thrombosis: Recanalization following intravenous thrombolysis is
dependent on thrombus length
#MMPMID29466399
Janssen H
; Brückmann H
; Killer M
; Heck S
; Buchholz G
; Lutz J
PLoS One
2018[]; 13
(2
): e0193051
PMID29466399
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INTRODUCTION: 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. METHODS: In 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. RESULTS: 87% 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). CONCLUSIONS: Recanalization 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.
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