Long-term Outcome After Intravenous Thrombolysis of Basilar Artery Occlusion
CONTEXT Basilar artery occlusion (BAO) is an infrequent disease with high morbidity and mortality. Intra-arterial thrombolysis is advocated for treatment but is limited to use at specialized centers. OBJECTIVE To evaluate outcomes for patients with BAO treated with intravenous thrombolytic therapy....
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2004-10, Vol.292 (15), p.1862-1866 |
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| creator | Lindsberg, Perttu J Soinne, Lauri Tatlisumak, Turgut Roine, Risto O Kallela, Mikko Häppölä, Olli Kaste, Markku |
| description | CONTEXT Basilar artery occlusion (BAO) is an infrequent disease with high morbidity
and mortality. Intra-arterial thrombolysis is advocated for treatment but
is limited to use at specialized centers. OBJECTIVE To evaluate outcomes for patients with BAO treated with intravenous
thrombolytic therapy. DESIGN, SETTING, AND PARTICIPANTS During 1995 to 2003, 50 consecutive patients with angiographically proven
BAO were treated according to an institutional therapy protocol based on intravenous
thrombolysis with recombinant tissue plasminogen activator (alteplase). Patients
were treated at an urban university teaching hospital receiving all patients
with ischemic stroke who were considered for thrombolysis in a catchment area
of 1.5 million inhabitants in Helsinki, Finland. INTERVENTION Intravenous administration of alteplase (0.9 mg/kg) during a 1-hour
infusion. MAIN OUTCOME MEASURES Basilar artery recanalization determined by magnetic resonance angiography
and clinical outcomes at 3 months and at 1 year or longer determined by modified
Rankin Scale and Barthel Index scores. RESULTS Recanalization was studied in 43 patients and verified in 26 (52%) of
all patients. By 3 months, 20 patients (40%) had died while 11 had good outcomes
(modified Rankin Scale score, 0-2); 12 (24%) reached independence in activities
of daily living (Barthel Index score, 95-100), and 6 (16%) were severely disabled
(Barthel Index score, 0-50). In the long term (median follow-up 2.8 years),
15 patients (30%) reached good outcomes (modified Rankin Scale score, 0-2)
while 23 (46%) died. CONCLUSIONS Intravenous administration of alteplase for patients with BAO appears
to be associated with rates of survival, recanalization, and independent functional
outcome comparable with those reported with endovascular approaches. These
data suggest that a randomized trial is needed to compare these approaches
for treatment of BAO. |
| doi_str_mv | 10.1001/jama.292.15.1862 |
| format | Article |
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and mortality. Intra-arterial thrombolysis is advocated for treatment but
is limited to use at specialized centers. OBJECTIVE To evaluate outcomes for patients with BAO treated with intravenous
thrombolytic therapy. DESIGN, SETTING, AND PARTICIPANTS During 1995 to 2003, 50 consecutive patients with angiographically proven
BAO were treated according to an institutional therapy protocol based on intravenous
thrombolysis with recombinant tissue plasminogen activator (alteplase). Patients
were treated at an urban university teaching hospital receiving all patients
with ischemic stroke who were considered for thrombolysis in a catchment area
of 1.5 million inhabitants in Helsinki, Finland. INTERVENTION Intravenous administration of alteplase (0.9 mg/kg) during a 1-hour
infusion. MAIN OUTCOME MEASURES Basilar artery recanalization determined by magnetic resonance angiography
and clinical outcomes at 3 months and at 1 year or longer determined by modified
Rankin Scale and Barthel Index scores. RESULTS Recanalization was studied in 43 patients and verified in 26 (52%) of
all patients. By 3 months, 20 patients (40%) had died while 11 had good outcomes
(modified Rankin Scale score, 0-2); 12 (24%) reached independence in activities
of daily living (Barthel Index score, 95-100), and 6 (16%) were severely disabled
(Barthel Index score, 0-50). In the long term (median follow-up 2.8 years),
15 patients (30%) reached good outcomes (modified Rankin Scale score, 0-2)
while 23 (46%) died. CONCLUSIONS Intravenous administration of alteplase for patients with BAO appears
to be associated with rates of survival, recanalization, and independent functional
outcome comparable with those reported with endovascular approaches. These
data suggest that a randomized trial is needed to compare these approaches
for treatment of BAO.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.292.15.1862</identifier><identifier>PMID: 15494584</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood vessels ; Brain ; Clinical outcomes ; Drug therapy ; Female ; Fibrinolytic Agents - therapeutic use ; General aspects ; Humans ; Magnetic Resonance Angiography ; Male ; Medical sciences ; Medical treatment ; Middle Aged ; Quality of Life ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator - therapeutic use ; Treatment Outcome ; Vertebrobasilar Insufficiency - diagnosis ; Vertebrobasilar Insufficiency - drug therapy</subject><ispartof>JAMA : the journal of the American Medical Association, 2004-10, Vol.292 (15), p.1862-1866</ispartof><rights>2004 INIST-CNRS</rights><rights>Copyright American Medical Association Oct 20, 2004</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a437t-3a4b582321385a095ba26114629f784cb417687f1ce1b16e7e942dd7492d568f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.292.15.1862$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.292.15.1862$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76458,76461</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16183417$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15494584$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lindsberg, Perttu J</creatorcontrib><creatorcontrib>Soinne, Lauri</creatorcontrib><creatorcontrib>Tatlisumak, Turgut</creatorcontrib><creatorcontrib>Roine, Risto O</creatorcontrib><creatorcontrib>Kallela, Mikko</creatorcontrib><creatorcontrib>Häppölä, Olli</creatorcontrib><creatorcontrib>Kaste, Markku</creatorcontrib><title>Long-term Outcome After Intravenous Thrombolysis of Basilar Artery Occlusion</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT Basilar artery occlusion (BAO) is an infrequent disease with high morbidity
and mortality. Intra-arterial thrombolysis is advocated for treatment but
is limited to use at specialized centers. OBJECTIVE To evaluate outcomes for patients with BAO treated with intravenous
thrombolytic therapy. DESIGN, SETTING, AND PARTICIPANTS During 1995 to 2003, 50 consecutive patients with angiographically proven
BAO were treated according to an institutional therapy protocol based on intravenous
thrombolysis with recombinant tissue plasminogen activator (alteplase). Patients
were treated at an urban university teaching hospital receiving all patients
with ischemic stroke who were considered for thrombolysis in a catchment area
of 1.5 million inhabitants in Helsinki, Finland. INTERVENTION Intravenous administration of alteplase (0.9 mg/kg) during a 1-hour
infusion. MAIN OUTCOME MEASURES Basilar artery recanalization determined by magnetic resonance angiography
and clinical outcomes at 3 months and at 1 year or longer determined by modified
Rankin Scale and Barthel Index scores. RESULTS Recanalization was studied in 43 patients and verified in 26 (52%) of
all patients. By 3 months, 20 patients (40%) had died while 11 had good outcomes
(modified Rankin Scale score, 0-2); 12 (24%) reached independence in activities
of daily living (Barthel Index score, 95-100), and 6 (16%) were severely disabled
(Barthel Index score, 0-50). In the long term (median follow-up 2.8 years),
15 patients (30%) reached good outcomes (modified Rankin Scale score, 0-2)
while 23 (46%) died. CONCLUSIONS Intravenous administration of alteplase for patients with BAO appears
to be associated with rates of survival, recanalization, and independent functional
outcome comparable with those reported with endovascular approaches. These
data suggest that a randomized trial is needed to compare these approaches
for treatment of BAO.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Blood vessels</subject><subject>Brain</subject><subject>Clinical outcomes</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>General aspects</subject><subject>Humans</subject><subject>Magnetic Resonance Angiography</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Quality of Life</subject><subject>Stroke</subject><subject>Thrombolytic Therapy</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Vertebrobasilar Insufficiency - diagnosis</subject><subject>Vertebrobasilar Insufficiency - drug therapy</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0c9LwzAUB_AgipvTu16kCHpr7cuvJsc5_DEo7DLPJU1T7WibmbTC_nsjmwzM5fF4Hx5fXhC6hjSBNIXHjepUgiVOgCUgOD5BU2BExIRJcYqmaSpFnFFBJ-jC-00aHpDsHE2AUUmZoFOU57b_iAfjumg1Dtp2JprXoY2W_eDUt-nt6KP1p7Ndadudb3xk6-hJ-aZVLpq7IHfRSut29I3tL9FZrVpvrg51ht5fnteLtzhfvS4X8zxWlGRDTBQtmcAEAxFMpZKVCnMAyrGsM0F1SSHjIqtBGyiBm8xIiqsqoxJXjIuazNDDfu_W2a_R-KHoGq9N26rehLwF51ISntIA7_7BjR1dH7IVGIBgTMQvuj2gsexMVWxd0ym3K_6OFMD9ASivVVs71evGHx0HQULk4G72LvzKcSolD1f_Abj6fNc</recordid><startdate>20041020</startdate><enddate>20041020</enddate><creator>Lindsberg, Perttu J</creator><creator>Soinne, Lauri</creator><creator>Tatlisumak, Turgut</creator><creator>Roine, Risto O</creator><creator>Kallela, Mikko</creator><creator>Häppölä, Olli</creator><creator>Kaste, Markku</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20041020</creationdate><title>Long-term Outcome After Intravenous Thrombolysis of Basilar Artery Occlusion</title><author>Lindsberg, Perttu J ; 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and mortality. Intra-arterial thrombolysis is advocated for treatment but
is limited to use at specialized centers. OBJECTIVE To evaluate outcomes for patients with BAO treated with intravenous
thrombolytic therapy. DESIGN, SETTING, AND PARTICIPANTS During 1995 to 2003, 50 consecutive patients with angiographically proven
BAO were treated according to an institutional therapy protocol based on intravenous
thrombolysis with recombinant tissue plasminogen activator (alteplase). Patients
were treated at an urban university teaching hospital receiving all patients
with ischemic stroke who were considered for thrombolysis in a catchment area
of 1.5 million inhabitants in Helsinki, Finland. INTERVENTION Intravenous administration of alteplase (0.9 mg/kg) during a 1-hour
infusion. MAIN OUTCOME MEASURES Basilar artery recanalization determined by magnetic resonance angiography
and clinical outcomes at 3 months and at 1 year or longer determined by modified
Rankin Scale and Barthel Index scores. RESULTS Recanalization was studied in 43 patients and verified in 26 (52%) of
all patients. By 3 months, 20 patients (40%) had died while 11 had good outcomes
(modified Rankin Scale score, 0-2); 12 (24%) reached independence in activities
of daily living (Barthel Index score, 95-100), and 6 (16%) were severely disabled
(Barthel Index score, 0-50). In the long term (median follow-up 2.8 years),
15 patients (30%) reached good outcomes (modified Rankin Scale score, 0-2)
while 23 (46%) died. CONCLUSIONS Intravenous administration of alteplase for patients with BAO appears
to be associated with rates of survival, recanalization, and independent functional
outcome comparable with those reported with endovascular approaches. These
data suggest that a randomized trial is needed to compare these approaches
for treatment of BAO.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>15494584</pmid><doi>10.1001/jama.292.15.1862</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | JAMA : the journal of the American Medical Association, 2004-10, Vol.292 (15), p.1862-1866 |
| issn | 0098-7484 1538-3598 |
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| source | MEDLINE; American Medical Association Journals |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Blood vessels Brain Clinical outcomes Drug therapy Female Fibrinolytic Agents - therapeutic use General aspects Humans Magnetic Resonance Angiography Male Medical sciences Medical treatment Middle Aged Quality of Life Stroke Thrombolytic Therapy Tissue Plasminogen Activator - therapeutic use Treatment Outcome Vertebrobasilar Insufficiency - diagnosis Vertebrobasilar Insufficiency - drug therapy |
| title | Long-term Outcome After Intravenous Thrombolysis of Basilar Artery Occlusion |
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