Semin Neurol 2021; 41(01): 039-045
DOI: 10.1055/s-0040-1722638
Review Article

Basilar Artery Occlusion and Emerging Treatments

Zuolu Liu
1   Department of Neurology and UCLA Stroke Center, University of California, Los Angeles, Los Angeles, California
,
David S. Liebeskind
1   Department of Neurology and UCLA Stroke Center, University of California, Los Angeles, Los Angeles, California
2   Neurovascular Imaging Research Core, University of California, Los Angeles, Los Angeles, California
› Author Affiliations

Abstract

Basilar artery occlusion is a relatively uncommon but neurologically devastating condition. If revascularization is not achieved, the potential for death and disability is substantial. During the last several years, there have been positive endovascular stroke trials for the treatment of large vessel occlusion; however, all of them excluded patients with basilar artery occlusion. The current treatment of basilar artery occlusion is still founded on small observational studies or meta-analyses. As case selection for revascularization and treatment protocols often vary widely across institutions, sample sizes remain limited. In this article, we aim to review some of the larger observational studies in stroke due to basilar artery occlusion, considering potential treatment strategies and resultant outcomes.



Publication History

Article published online:
14 January 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Schonewille WJ, Wijman CAC, Michel P. et al; BASICS Study Group. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 2009; 8 (08) 724-730
  • 2 Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol 2011; 10 (11) 1002-1014
  • 3 Beyer SE, Hunink MG, Schöberl F. et al. Different imaging strategies in patients with possible basilar artery occlusion: cost-effectiveness analysis. Stroke 2015; 46 (07) 1840-1849
  • 4 Hacke W, Zeumer H, Ferbert A, Brückmann H, del Zoppo GJ. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 1988; 19 (10) 1216-1222
  • 5 Eckert B, Koch C, Thomalla G. et al. Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke 2005; 36 (06) 1160-1165
  • 6 Schonewille WJ, Algra A, Serena J, Molina CA, Kappelle LJ. Outcome in patients with basilar artery occlusion treated conventionally. J Neurol Neurosurg Psychiatry 2005; 76 (09) 1238-1241
  • 7 Strbian D, Sairanen T, Silvennoinen H, Salonen O, Lindsberg PJ. Intravenous thrombolysis of basilar artery occlusion: thrombus length versus recanalization success. Stroke 2014; 45 (06) 1733-1738
  • 8 Kubik CS, Adams RD. Occlusion of the basilar artery; a clinical and pathological study. Brain 1946; 69 (02) 73-121
  • 9 Gilberti N, Gamba M, Premi E. et al. Endovascular mechanical thrombectomy in basilar artery occlusion: variables affecting recanalization and outcome. J Neurol 2016; 263 (04) 707-713
  • 10 Singer OC, Berkefeld J, Nolte CH. et al; ENDOSTROKE Study Group. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 2015; 77 (03) 415-424
  • 11 Castaigne P, Lhermttte F, Gautier JC. et al. Arterial occlusions in the vertebro-basilar system data about patterns of occlusions in the vertebro-basilar arterial system appear to be scarce. J Neurol 1973; 96 (01) 133-154
  • 12 Lindsberg PJ, Soinne L, Tatlisumak T. et al. Long-term outcome after intravenous thrombolysis of basilar artery occlusion. JAMA 2004; 292 (15) 1862-1866
  • 13 Lindsberg PJ, Mattle HP. Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 2006; 37 (03) 922-928
  • 14 Smith E, Delargy M. Locked-in syndrome. BMJ 2005; 330 (7488): 406-409
  • 15 Demel SL, Broderick JP. Basilar occlusion syndromes: an update. Neurohospitalist 2015; 5 (03) 142-150
  • 16 Oppenheim C, Stanescu R, Dormont D. et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 2000; 21 (08) 1434-1440
  • 17 Ostrem JL, Saver JL, Alger JR. et al. Acute basilar artery occlusion: diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies. Stroke 2004; 35 (02) e30-e34
  • 18 Nagel S, Schellinger PD, Hartmann M. et al. Therapy of acute basilar artery occlusion: intraarterial thrombolysis alone vs bridging therapy. Stroke 2009; 40 (01) 140-146
  • 19 Devuyst G, Bogousslavsky J, Meuli R, Moncayo J, de Freitas G, van Melle G. Stroke or transient ischemic attacks with basilar artery stenosis or occlusion: clinical patterns and outcome. Arch Neurol 2002; 59 (04) 567-573
  • 20 Chimowitz MI, Lynn MJ, Howlett-Smith H. et al; Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352 (13) 1305-1316
  • 21 Kasner SE, Lynn MJ, Chimowitz MI. et al; Warfarin Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators. Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID. Neurology 2006; 67 (07) 1275-1278
  • 22 Chimowitz MI, Lynn MJ, Derdeyn CP. et al; SAMMPRIS Trial Investigators. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365 (11) 993-1003
  • 23 Kwon SU, Cho YJ, Koo JS. et al. Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis. Stroke 2005; 36 (04) 782-786
  • 24 Uchiyama S, Sakai N, Toi S. et al; CATHARSIS Study Group. Final results of cilostazol-aspirin therapy against recurrent stroke with intracranial artery stenosis (CATHARSIS). Cerebrovasc Dis Extra 2015; 5 (01) 1-13
  • 25 Kwon SU, Hong KS, Kang DW. et al. Efficacy and safety of combination antiplatelet therapies in patients with symptomatic intracranial atherosclerotic stenosis. Stroke 2011; 42 (10) 2883-2890
  • 26 Wong KSL, Chen C, Fu J. et al; CLAIR study investigators. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial. Lancet Neurol 2010; 9 (05) 489-497
  • 27 Markus HS, Droste DW, Kaps M. et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using Doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 2005; 111 (17) 2233-2240
  • 28 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333 (24) 1581-1587
  • 29 Hacke W, Kaste M, Bluhmki E. et al; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359 (13) 1317-1329
  • 30 van der Hoeven EJ, Schonewille WJ, Vos JA. et al; BASICS Study Group. The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial. Trials 2013; 14: 200
  • 31 Bivard A, Huang X, Levi CR. et al. Tenecteplase in ischemic stroke offers improved recanalization: analysis of 2 trials. Neurology 2017; 89 (01) 62-67
  • 32 Logallo N, Novotny V, Assmus J. et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol 2017; 16 (10) 781-788
  • 33 Parsons M, Spratt N, Bivard A. et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med 2012; 366 (12) 1099-1107
  • 34 Campbell BCV, Mitchell PJ, Churilov L. et al; EXTEND-IA TNK Investigators. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med 2018; 378 (17) 1573-1582
  • 35 Macleod MR, Davis SM, Mitchell PJ. et al. Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke. Cerebrovasc Dis 2005; 20 (01) 12-17
  • 36 Ezaki Y, Tsutsumi K, Onizuka M. et al. Retrospective analysis of neurological outcome after intra-arterial thrombolysis in basilar artery occlusion. Surg Neurol 2003; 60 (05) 423-429 , discussion 429–430
  • 37 Arnold M, Nedeltchev K, Schroth G. et al. Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis. J Neurol Neurosurg Psychiatry 2004; 75 (06) 857-862
  • 38 McFadyen JD, Schaff M, Peter K. Current and future antiplatelet therapies: emphasis on preserving haemostasis. Nat Rev Cardiol 2018; 15 (03) 181-191
  • 39 Nagel S, Schellinger PD, Hartmann M. et al. Therapy of acute basilar artery occlusion: intraarterial thrombolysis alone vs bridging therapy. Stroke 2009; 40 (01) 140-146
  • 40 Barlinn K, Becker U, Puetz V. et al. Combined treatment with intravenous abciximab and intraarterial tPA yields high recanalization rate in patients with acute basilar artery occlusion. J Neuroimaging 2012; 22 (02) 167-171
  • 41 Chiti A, Gialdini G, Terni E. et al. Intra-arterial tissue plasminogen activator and abciximab in patients with acute basilar artery occlusion. Neurol Sci 2013; 34 (10) 1871-1873
  • 42 Ciccone A, Motto C, Abraha I, Cozzolino F, Santilli I. Glycoprotein IIb–IIIa inhibitors for acute ischemic stroke. Stroke 2014; 45 (08) 155-156
  • 43 Berkhemer OA, Fransen PSS, Beumer D. et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (01) 11-20
  • 44 Campbell BCV, Mitchell PJ, Kleinig TJ. et al; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372 (11) 1009-1018
  • 45 Goyal M, Demchuk AM, Menon BK. et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372 (11) 1019-1030
  • 46 Saver JL, Goyal M, Bonafe A. et al; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372 (24) 2285-2295
  • 47 Gory B, Eldesouky I, Sivan-Hoffmann R. et al. Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review. J Neurol Neurosurg Psychiatry 2016; 87 (05) 520-525
  • 48 Kang DH, Jung C, Yoon W. et al. Endovascular thrombectomy for acute basilar artery occlusion: a multicenter retrospective observational study. J Am Heart Assoc 2018; 7 (14) 1-9
  • 49 Smith WS, Sung G, Saver J. et al; Multi MERCI Investigators. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 2008; 39 (04) 1205-1212
  • 50 Kaneko J, Ota T, Tagami T. et al; TREAT Study Group. Endovascular treatment of acute basilar artery occlusion: Tama-REgistry of Acute Thrombectomy (TREAT) study. J Neurol Sci 2019; 401 (April): 29-33
  • 51 Gory B, Mazighi M, Blanc R. et al. Mechanical thrombectomy in basilar artery occlusion: influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs stent retriever). J Neurosurg 2018; 129 (06) 1482-1491
  • 52 Powers WJ, Rabinstein AA, Ackerson T. et al; American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49 (03) e46-e110
  • 53 Vergouwen MDI, Algra A, Pfefferkorn T. et al; Basilar Artery International Cooperation Study (BASICS) Study Group. Time is brain(stem) in basilar artery occlusion. Stroke 2012; 43 (11) 3003-3006
  • 54 Strbian D, Sairanen T, Silvennoinen H, Salonen O, Kaste M, Lindsberg PJ. Thrombolysis of basilar artery occlusion: impact of baseline ischemia and time. Ann Neurol 2013; 73 (06) 688-694
  • 55 Greving JP, Schonewille WJ, Wijman CAC, Michel P, Kappelle LJ, Algra A. BASICS Study Group. Predicting outcome after acute basilar artery occlusion based on admission characteristics. Neurology 2012; 78 (14) 1058-1063
  • 56 Rangaraju S, Jovin TG, Frankel M. et al; BASICS Study Group. Neurologic examination at 24 to 48 hours predicts functional outcomes in basilar artery occlusion stroke. Stroke 2016; 47 (10) 2534-2540
  • 57 Mokin M, Sonig A, Sivakanthan S. et al. Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes. Stroke 2016; 47 (03) 782-788
  • 58 Qureshi AI, Siddiqui AM, Kim SH. et al. Reocclusion of recanalized arteries during intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 2004; 25 (02) 322-328
  • 59 Kim GE, Yoon W, Kim SK. et al. Incidence and clinical significance of acute reocclusion after emergent angioplasty or stenting for underlying intracranial stenosis in patients with acute stroke. AJNR Am J Neuroradiol 2016; 37 (09) 1690-1695