Ultra-early Thrombolysis and Magnetic Resonance Imaging in Basilar Artery Occlusion

Abstract

Basilar artery occlusion (BA occlusion) is a catastrophic event and a neurologic emergency that requires a rapid diagnosis and therapy. High mortality of patients treated only with nonthrombolytic methods has been reported several times in the literature.
We treated a series of 9 patients with BA occlusion that underwent intra-arterial thrombolysis over a period of 9 years (1995-2004). Ultra-early MRI, including diffusion weighted imaging (DWI) and MR angiography were performed in 6 patients. We retrospectively investigated MRI findings, clinical outcome and indication of thrombolysis in BA occlusion.
Initial clinical status was critical in all cases. Five patients had atrial fibrillation. The DWI was performed 60 to 210 minutes after onset and showed different patterns of ischemic lesions. In 3 patients, no signs of high intensity areas in the brain stem could be identified. The remaining demonstrated multiple lesions involving the brain stem. The clinical outcome was unfavorable (SD, veg, dead) in the 3 patients with residual lesion in brain stem in spite of successful recanalization.
We present the clinical outcomes of 6 patients with BA occlusion, focusing especially on ultra-early MRI findings. These results suggest that success is possible in patients with no signs of high-intensity areas in the brain stem in spite of its poorer condition before treatment if reperfusion was achieved with thrombolysis.