Combined Intravenous and Intra-arterial Superselective Low-dose Thrombolysis for Basilar Stroke: 2 Cases Report.

Treatment of acute ischemic stroke attempts to open the occluded blood vessels in order to re-establish blood flow and to improve outcomes [1] Endovascular thrombectomy for large vessel ischaemic stroke substantially reduces disability, with recent positive randomised trials leading to guideline changes worldwide[2]. However basilar artery occlusion was excluded from the trials and there are no guidelines for endovascular treatment of basilar stroke.

We demonstrate 2 cases of combined intravenous (IV) and superselective direct low-dose intra-arterial (LD IA) treatment of basilar stroke, resulted with complete recanalization and clinical improvement. Standard IV rtPA dosage and low-dose intraarterial rtPA bolus injections were applied. Any peri-procedural complications were recognised.

Conclusion: We conclude that endovascular superselective direct LD IA treatment of basilar stroke in combination with IV thrombolysis is an effective, fast and safe treatment strategy for appropriately selected patients. However, there are no guidelines for endovascular treatment of basilaris stroke and evidence-based rtPA dosage for intra-arterial injection still unknown. More randomized studies are needed.

References

1. Bivard A, Lin L, Parsonsb MW (2013) Review of stroke thrombolytics. J Stroke 15: 90–98. doi: 10.5853/jos.2013.15.2.90 [PMC free article] [PubMed]
2. Campbell BCV, Donnan GA, Mitchell PJ, et al Endovascular thrombectomy for stroke: current best practice and future goals Stroke and Vascular Neurology 2016;1:doi: 10.1136/svn-2015-000004
3.