Stroke attributable to acute basilar occlusion

Acute basilar artery occlusion carries a high risk of disabling stroke or death. Fast recanalization of the vessel is the mainstay of the therapy. Recanalization may be achieved by intravenous or intra-arterial administration of thrombolytics. These procedures are currently used as life-saving interventions, despite the low level of evidence supporting their efficacy, because of the bad prognosis of the disease. Intravenous thrombolysis may be started earlier, but it is less often used, mainly for historic reasons; intra-arterial measures are possibly more effective in achieving recanalization but require extra time before they can be started and demand a considerable amount of resources. The basilar artery does not recanalize in approximately one third of patients; this result has not been modified over the past two decades by these treatments and probably will not change. Combined mechanical and intra-arterial thrombolysis may be more efficient in achieving basilar artery recanalization, but the impact of this combined intervention on the final outcome has not been evaluated. Because time is critical, as in every stroke, implementation of a specific treatment protocol for this condition, including one of the aforementioned treatments, and eventual transfer to a secondary-care unit will save time and improve prognosis.