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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
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Prolonged low-dose thrombolysis in posterior circulation stroke.
C Hametner1, L Kellert, R Veltkamp
1Department of Neurology, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany, Christian.Hametner@med.uni-heidelberg.de.
Neurocritical Care
|November 20, 2013
Summary
Prolonged low-dose thrombolysis using recombinant tissue plasminogen activator (rtPA) shows promise for basilar artery thrombosis patients ineligible for standard treatment. This approach demonstrated a 64% favorable outcome rate, suggesting potential as an individualized therapy.
Area of Science:
- Neurology
- Vascular Medicine
- Interventional Cardiology
Background:
- Investigating prolonged, low-dose intravenous thrombolysis for posterior circulation stroke patients with basilar artery thrombosis.
- Focusing on patients ineligible for standard recombinant tissue plasminogen activator (rtPA) therapy.
Purpose of the Study:
- To assess the feasibility, preliminary safety, and efficacy of this alternative thrombolysis approach.
- To evaluate outcomes in a high-risk patient cohort.
Main Methods:
- Retrospective analysis of 14 basilar artery thrombosis patients treated with prolonged (>1 h), low-dose (≤20 mg) rtPA.
- Treatment administered between January 2005 and November 2012, with median symptom onset to treatment time of 63 hours.
Main Results:
- A median rtPA dose of 5.21 μg/kg/h was given over 24 hours.
- 57% showed thrombus reduction or resolution; 64% achieved a favorable outcome (mRS 0-2) at 90 days.
- No symptomatic intracerebral hemorrhage occurred; one spinal epidural hematoma was noted.
Conclusions:
- Prolonged low-dose rtPA may be a viable individualized treatment for selected basilar artery thrombosis patients.
- Further prospective trials are warranted to confirm safety and efficacy.
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