From the Guidelines
The treatment for an occluded basilar artery requires immediate medical intervention with endovascular therapy (EVT), which should be based on the potential benefits and risks of the treatment for the individual patient, and made by a physician with stroke expertise in consultation with the patient and/or substitute decision-makers 1.
Key Considerations
- The decision to treat with EVT should be made on a case-by-case basis, taking into account the individual patient's condition and the potential benefits and risks of the treatment.
- EVT is a highly effective treatment for large vessel occlusions, including basilar artery occlusion, and can significantly improve outcomes in eligible patients.
- The treatment should be initiated as soon as possible, with the goal of restoring blood flow to the affected area of the brain.
Treatment Options
- EVT is the preferred treatment for patients presenting within 24 hours of symptom onset, involving the insertion of a catheter to physically remove the clot 1.
- Intravenous thrombolysis using alteplase (tPA) may be considered in some cases, but the evidence for its use in basilar artery occlusion is limited 1.
- Antiplatelet therapy with aspirin and anticoagulation with heparin or warfarin may be started after ruling out hemorrhage, depending on the individual patient's condition.
Supportive Care
- Blood pressure management, maintaining adequate oxygenation, and preventing complications are crucial components of supportive care.
- The goal of treatment is to restore blood flow as quickly as possible to prevent permanent brainstem damage, which can result in locked-in syndrome or death.
Evidence-Based Recommendations
- The most recent and highest quality study recommends EVT as the preferred treatment for large vessel occlusions, including basilar artery occlusion 1.
- The evidence for intravenous thrombolysis using alteplase (tPA) is limited, and its use should be considered on a case-by-case basis 1.
From the Research
Treatment Options for Occluded Basilar Artery
The treatment for an occluded basilar artery includes several options, with varying degrees of effectiveness. Some of the treatment options are:
- Endovascular thrombectomy: This is a minimally invasive procedure that involves removing the blood clot from the basilar artery using a mechanical device 2, 3, 4.
- Intravenous thrombolysis: This involves administering a clot-busting medication, such as tissue plasminogen activator (tPA), through a vein to dissolve the blood clot 5, 6.
- Intra-arterial thrombolysis: This involves administering a clot-busting medication directly into the affected artery to dissolve the blood clot 5.
Effectiveness of Treatment Options
The effectiveness of these treatment options varies, with some studies suggesting that endovascular thrombectomy may be more effective than intravenous thrombolysis in certain cases 2, 4. However, other studies have found that intravenous thrombolysis can be effective in treating basilar artery occlusion, especially in patients with moderate-to-severe symptoms 6.
Factors Affecting Treatment Outcomes
Several factors can affect the outcomes of treatment for basilar artery occlusion, including:
- Time from symptom onset to treatment: Earlier treatment is generally associated with better outcomes 2, 6.
- Severity of symptoms: Patients with more severe symptoms may be more likely to benefit from aggressive treatment, such as endovascular thrombectomy 2, 3.
- Presence of underlying medical conditions: Patients with certain underlying medical conditions, such as intracranial atherosclerotic disease, may be more likely to experience complications from treatment 2.
Comparison of Treatment Options
Some studies have compared the effectiveness of different treatment options for basilar artery occlusion. For example, one study found that endovascular thrombectomy was associated with better outcomes than intravenous thrombolysis in patients with moderate-to-severe symptoms 2. However, another study found that intravenous thrombolysis was associated with comparable outcomes to endovascular thrombectomy in patients with basilar artery occlusion 6.