Abstract
Background
We aimed to investigate the feasibility, preliminary safety, and efficacy of prolonged low-dose intravenous thrombolysis in posterior circulation stroke patients with a thrombus lodged in the basilar artery who were ineligible for standard rtPA administration.
Methods
We retrospectively analyzed consecutively collected patients in our stroke database who suffered from a basilar artery thrombosis and were treated with prolonged (>1 h), intravenous, low-dose (≤20 mg) rtPA between 01/2005 and 11/2012.
Results
Patients included in this study (n = 14) were 68.5 years (IQR 55.5; 72.75) of age and presented with a median NIHSS of 2 (1; 5.25). Median time from symptom onset to treatment was 63 h (33; 141). A median dose of 5.21 μg/kg h (4.46; 6.25) rtPA was administered over 24 h (min 10; max 48). No patient experienced symptomatic intracerebral hemorrhage, one patient developed a spinal epidural hematoma, and two elderly patients were switched to comfort care and died. In eight patients (57 %) a decrease in thrombus size or no thrombus at all was detected on control imaging. Nine patients (64 %) had a favorable outcome (mRS 0–2) at day 90.
Conclusions
Prolonged low-dose thrombolysis with rtPA may be considered as individual treatment option in selected high-risk patients with basilar artery thrombosis. Presented data may lay the groundwork to further investigate safety and efficacy in a prospective trial.
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Conflict of interest
CH, LK, SN, and RV report no conflicts and have nothing to disclose. WH and PR received speaker honoraria and travel expenses from Boehringer Ingelheim (manufacturer of Alteplase®).
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Hametner, C., Kellert, L., Veltkamp, R. et al. Prolonged Low-Dose Thrombolysis in Posterior Circulation Stroke. Neurocrit Care 21, 114–118 (2014). https://doi.org/10.1007/s12028-013-9891-5
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DOI: https://doi.org/10.1007/s12028-013-9891-5