Intravenous r-TPA in vertebrobasilar acute infarcts

Area of Science:

• Neurology
• Vascular Neurology
• Emergency Medicine

Background:

• Vertebrobasilar (VB) artery system ischemia is a critical neurological emergency.
• Timely reperfusion therapy is crucial for improving outcomes in acute ischemic stroke.
• Limited data exists on the efficacy and safety of intravenous thrombolysis in VB ischemia within extended time windows.

Purpose of the Study:

• To evaluate the safety and efficacy of intravenous recombinant tissue plasminogen activator (r-TPA) in patients with acute vertebrobasilar (VB) ischemia.
• To assess functional outcomes in patients treated within a 7-hour window.

Main Methods:

• Retrospective analysis of clinical data from 18 consecutive patients treated with IV r-TPA for suspected VB acute ischemia.
• Treatment administered within 7 hours of symptom onset.
• Outcomes assessed using the modified Rankin Scale (mRS) at 3 months.

Main Results:

• The mean delay to treatment was 5 ± 3.6 hours.
• Mean baseline NIH Stroke Scale score was 17 ± 4.
• At 3 months, 10 patients (55.6%) achieved an independent outcome (mRS 0-2), while 8 patients (44.4%) had a poor outcome (mRS 3-6).

Conclusions:

• Intravenous r-TPA administration within a 7-hour window for acute VB ischemia may be a safe and effective treatment strategy.
• The findings suggest potential for improved functional independence in a significant proportion of treated patients.
• Further prospective studies are warranted to confirm these results.