From the Guidelines
Basilar artery occlusion at its termination should be treated with endovascular therapy (EVT), such as mechanical thrombectomy with stent retrievers, as it may be reasonable for carefully selected patients 1.
Key Considerations
- The benefits of EVT are uncertain, but it may be considered for patients with acute ischemic stroke (AIS) who have causative occlusion of the basilar artery and can be treated within 6 hours of symptom onset 1.
- EVT should be considered for posterior circulation occlusions, including basilar artery occlusion, depending on symptom severity and patient factors 1.
- Intravenous thrombolysis with alteplase may also be beneficial for basilar artery occlusion, with some studies suggesting comparable outcomes to endovascular approaches 1.
- Combination intravenous and intra-arterial fibrinolysis may be a more efficient way to rapidly recanalize major intracranial arterial occlusions, including proximal intracranial arterial occlusions such as the basilar artery 1.
Treatment Options
- Mechanical thrombectomy with stent retrievers: may be reasonable for carefully selected patients with AIS and basilar artery occlusion 1.
- Intravenous thrombolysis with alteplase: may be beneficial for basilar artery occlusion, with some studies suggesting comparable outcomes to endovascular approaches 1.
- Combination intravenous and intra-arterial fibrinolysis: may be a more efficient way to rapidly recanalize major intracranial arterial occlusions, including proximal intracranial arterial occlusions such as the basilar artery 1.
Important Factors
- Time from symptom onset: treatment should be initiated as soon as possible, ideally within 6 hours of symptom onset 1.
- Symptom severity: treatment should be considered based on symptom severity and patient factors 1.
- Patient factors: such as age, baseline functional status, and patient wishes, should be taken into account when considering treatment 1.
From the Research
Basilar Artery Occlusion at its Termination
- Basilar artery occlusion is a serious medical condition with high mortality rates, especially if not rapidly diagnosed and treated 2, 3, 4.
- The occlusion can occur at its termination, which is a critical area supplying blood to the brainstem and cerebellum 4.
- The main causes of basilar artery occlusion are embolic or atherosclerotic, and it often presents with non-specific signs and symptoms such as vertigo, cephalalgia, reduced consciousness, or hemiparesis 2.
- Imaging studies, including computed tomography (CT), computed tomography angiography (CTA), and diffusion-weighted magnetic resonance imaging (DWI MRI), are crucial for accurate diagnosis and management of basilar artery occlusion 2, 5.
- Treatment options for basilar artery occlusion include intravenous thrombolysis, mechanical thrombectomy, or bridging therapy, with the goal of early recanalization and improved outcomes 2, 3, 5.
- Recent studies have yielded mixed results regarding the effectiveness of endovascular therapy (EVT) for basilar artery occlusion, highlighting the need for further research to determine the optimal treatment approach 5.