Artery basilar

Lindsberg and Mattle ° recently analyzed published case series reporting on the outcome of basilar artery occlusion (BAO) after lAT or IV thrombolysis. In 420 BAO patients treated with IV thrombolysis (76) and lAT (344), death or dependency was equally common 78% (59 of 76) and 76% (260 of 344). Recanalization was achieved more frequently with lAT (225 of 344 65%) than with IV thrombolysis (40 of 76 53% p = 0.05), but survival rates after IV thrombolysis (38 of 76 50%) and lAT (154 of 344 45%) were equal (p = 0.48). A total of 24% of patients treated with lAT and 22% treated with IV thrombolysis reached good outcomes (p = 0.82). Without recanalization, the likelihood of achieving a good outcome was close to nil (2%). The authors conclude that recanalization occurs in more than half of BAO patients treated with lAT or IV thrombolysis, and 45-55% of survivors regain functional independence. They advised that hospitals not equipped for lAT should consider setting up IV thrombolysis protocols for BAO since the effect of IVT did not appear to be much different from the effect of lAT. 

FIGURE 4.2 (Continued) A compliant balloon was used to perform angioplasty (c). Postangioplasty angiogram demonstrated complete recanalization of the basilar artery and its major branches (d and e). MRI performed 2 days later demonstrated only small areas of infarction in the cerebellar hemispheres (arrows—f and g) but no brainstem or occipital infarcts. 

Stenting of an acutely occluded intracranial vessel may provide fast recanalization by entrapping the thrombus between the stent and the vessel wall. A recent study in which 19 patients with acute occlusions at the ICA terminus n = 8), M1/M2 (n = 7), or basilar artery (n = 4) were treated with balloon-expandable stents showed a TIMI 2 and 3 recanalization rate of 79% and no symptomatic intracranial hemorrhages (Fig. 4.5). ... 

FIGURE 4.5 A 72-year-old man with medical history remarkable for hypertension and dyslipidemia presented with posterior circulation infarct (a). CTA and posterior circulation angiography (left vertebral artery injection) performed demonstrated severe mid-basilar artery stenosis (b and c). Left vertebral artery injection demonstrated near-complete reversal of the stenosis after a drug-eluting balloon expandable stent (Cypher, Cordis Johnson Johnson) was deployed (d). 

Mayer TE, Hamann GF, Brueckmann H. Mechanical extraction of a basilar-artery embolus with the use of flow reversal and a microbasket. N Engl J Med 2002 347 769-770. 

Yu W, Binder D, Foster-Barber A, Malek R, Smith WS, Higashida RT. Endovascular embolectomy of acute basilar artery occlusion. Neurology 2003 61 1421-1423. 

Lindsberg PJ, Mattie HP. Therapy of basilar artery occlusion a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 2006 37 922-928. 

Eckert B, Koch C, Thomalla G, Roether J, Zeumer H. Acute basilar artery occlusion treated with combined intravenous Abciximab and intra-arterial tissue plasminogen activator report of 3 cases. Stroke 2002 33 1424-1427. 

Bergui M, Stura G, Daniele D, Cerrato P, Berardino M, Bradac GB. Mechanical thrombolysis in ischemic stroke attributable to basilar artery occlusion as first-line treatment. Stroke 2006 37 145-150. 

Chapot R, Houdart E, Rogopoulos A, Mounayer C, Saint-Maurice JP, Merland JJ. Thromboaspiration in the basilar artery report of two cases. Am J Neuroradiol 2002 23 282-284. 

Junghans U, Seitz RJ, Wittsack HJ, Aulich A, Siebler M. Treatment of acute basilar artery thrombosis with a combination of systemic alteplase and tirofiban, a nonpeptide platelet glycoprotein Ilb/HIa inhibitor report of four cases. Radiology 2001 221 795-801. 

Kassell (Takahashi et al., 1993) has described the activity of a novel tropolone U88999E in a rabbit model of cerebral vasosjrasm. U88999E inhibits lipid peroxidation and acts as a calcium antagonist. Kassell showed that the compound relaxed preconstricted arterial rings in vitro (potency slightly less than flunarizine or dil-tiazem) and that it reduced vasospasm of basilar arteries after rabbit subarachnoid haemorrhage (Takahashi etal., 1993). 

Suggested Alternatives for Differential Diagnosis Meningitis, basilar artery blood clots (thrombosis), cardioembolic stroke, cavernous sinus syndromes, cerebral venous blood clots (thrombosis), confusional states and acute memory disorders, epileptic and epileptiform encephalopathies, febrile seizures, haemophilus meningitis, intracranial hemorrhage, leptomeningeal carcinomatosis, subdural pus (empyema), or bruise (hematoma). 

Vascular and hematologic effects Ginkgo exerts vascular effects through at least two mechanisms inhibition of platelet-activating factor (PAF) and nitric oxide mechanisms. Ginkgo extract relaxes the porcine basilar artery in a concentration-dependent and partly endothelium-dependent manner (Chen et al. 1997). It also enhances vasorelaxation created by transmural nerve stimulation in arteries with and without the endothelium intact, and is prevented by nitro-L-arginine, indicating that the effect is mediated by nitric oxide. 

Wl. White, R. R, Comparison of the inhibitory effects of antithrombin 111, 0 -2-macroglobulin, and thrombin in human basilar arteries Relevance to cerebral vasospasm. J. Cereb. Blood Flow Metab. 7(1), 68-73 ( 1987). 

Unlabeled Uses Acute peripheral occlusive disease, basilar artery occlusion, cerebral infarction, deep vein thrombosis, femoropopliteal artery occlusion, mesenteric or subclavian vein occlusion, pleural effusion (parapneumonic)... 

Basilar artery endothelial Muscle contraction inhibition Ea Kim et al., 1990... 

Ea-Kim, L., Malard, N., Oudart, N., 1990. Effects of a H3 histaminergic agonist on guinea pig basilar arteries in vitro. Fundam. Clin. Pharmacol. 4, 577. 

Biller J, Haberland C, Toffol GJ, O Reilly D, Tentler RL. Basilar artery occlusion in an adolescent girl a risk of oral contraceptives J Child Neurol 1986 l(4) 347-50. 

J.B. Salom, M.D. Barbera, J.M. Centeno, M. Orti, G. Torregrosa and E. Alborch, Relaxant effects of sodium nitroprusside and NONOates in rabbit basilar artery, Pharmacology, 57 (1998) 79-87. 

Ebersole BJ, Diglio CA, Kaufman DW, Berg KA. 5-Hydroxytryptaminerlike receptors linked to increases in intracellular calcium concentration and inhibition of cyclic AMP accumulation in cultured vascular smooth muscle cells derived from bovine basilar artery. J Pharmacol Exp Ther 1993 266 692-699. 

---