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Time window for recanalization in basilar artery occlusion
- Source :
- Lindsberg, Perttu J; Pekkola, Johanna; Strbian, Daniel; Sairanen, Tiina; Mattle, Heinrich; Schroth, Gerhard (2015). Time window for recanalization in basilar artery occlusion: Speculative synthesis. Neurology, 85(20), pp. 1806-1815. Lippincott Williams & Wilkins 10.1212/WNL.0000000000002129
- Publication Year :
- 2015
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2015.
-
Abstract
- Basilar artery occlusion (BAO) is one of the most devastating forms of stroke and few patients have good outcomes without recanalization. Most centers apply recanalization therapies for BAO up to 12-24 hours after symptom onset, which is a substantially longer time window than the 4.5 hours used in anterior circulation stroke. In this speculative synthesis, we discuss recent advances in BAO treatment in order to understand why and under which circumstances longer symptom duration might not necrotize the brainstem and turn therapeutic attempts futile. We raise the possibility that distinct features of the posterior circulation, e.g., highly developed, persistent collateral arterial network, reverse filling of the distal basilar artery, and delicate plasma flow siding the clot, might sustain brittle patency of brainstem perforators in the face of stepwise growth of the thrombus. Meanwhile, the tissue clock characterizing the rapid necrosis of a typical anterior circulation penumbra will not start. During this perilous time period, recanalization at any point would salvage the brainstem from eventual necrosis caused by imminent reinforcement and further building up of the clot.
- Subjects :
- medicine.medical_specialty
Time Factors
Arterial Occlusive Diseases
610 Medicine & health
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
medicine.artery
Catheterization, Peripheral
Vertebrobasilar Insufficiency
medicine
Basilar artery
Animals
Humans
Thrombus
Vertebrobasilar insufficiency
Stroke
business.industry
Penumbra
Basilar artery occlusion
medicine.disease
3. Good health
Surgery
Radiography
Treatment Outcome
Basilar Artery
Neurology (clinical)
Brainstem
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 1526632X and 00283878
- Volume :
- 85
- Database :
- OpenAIRE
- Journal :
- Neurology
- Accession number :
- edsair.doi.dedup.....f58fdfa10bc740f0d82f5f8dcbc6e1be