Clinical Diagnostics, Therapy and Outcome After Basilar Artery Thrombosis

Abstract

Acute basilar artery occlusion is a relatively rare but life threatening condition requiring rapid diagnosis and treatment. The circumstances and predictive value for outcome in these patients are not well documented. 88 patients with basilar artery occlusion treated in the Department of Neurology at Jena University Hospital from 1998 to 2007 were identified and studied. Of these, 45 were males and 43 females, aged between 20 and 92 years (median, 63 years). In 60.2%, MRI with MR angiography led to the diagnosis; 13.6% of all cases were diagnosed by cranial CT. 45 patients were treated with thrombolytic therapy with rt-PA (44/45) or urokinase (1/45; in 1999). Out of 45 patients, eight (17.7%) initially received systemic (i.v.) thrombolytic treatment. Recent research has suggested that for patients with unambiguous basilar artery thrombosis, the only promising treatment option is early thrombolytic treatment. The major clinical goal is to enable patients to live an independent life after the acute phase and, if required, rehabilitation. Consequently, this challenges the concept of a "thrombolysis at all costs" approach, especially in case of multi-morbidity, unidentifiable time frames, and comatose patients with regards to possible poor functional prognosis. An adequate therapy in the sense of an adaptable scheme, starting with immediate maximum therapy following diagnosis, and with defined decision points for possible therapeutic limitations at later stages of the disease course after ensuring poor prognosis may require further testing, depending on clinical conditions and the patients' documented, or presumable wishes.