Collateral circulation and outcome after basilar artery thrombolysis

Area of Science:

• Neurology
• Interventional Radiology
• Vascular Medicine

Background:

• Basilar artery thrombosis is a critical condition affecting neurological function.
• Intraarterial thrombolysis is a treatment option for basilar artery thrombosis.
• The role of collateral circulation in treatment outcomes is not fully understood.

Purpose of the Study:

• To investigate the relationship between collateral flow and patient outcomes following intraarterial thrombolytic treatment for basilar artery thrombosis.
• To assess the impact of collateral circulation on neurological recovery and survival rates.

Main Methods:

• Twenty-four patients with basilar artery thrombosis received intraarterial urokinase.
• Angiographic analysis characterized collateral flow, including the number of posterior communicating arteries (PCoAs).
• Collateral flow was correlated with symptom duration, Glasgow Coma Scale (GCS) score, 90-day modified Rankin score, and survival.

Main Results:

• Collateral flow to the basilar artery was associated with longer symptom duration before treatment.
• While overall survival (38%) and good neurologic outcomes (25%) were modest, collateral flow significantly impacted outcomes for distal or middle basilar artery thrombi (83% good outcome with flow vs. 17% without).
• Proximal basilar artery thrombosis was universally fatal, irrespective of collateral flow.

Conclusions:

• Collateral filling of the basilar artery is a positive prognostic indicator for neurologic outcome after intraarterial thrombolysis in acute basilar artery thrombosis, except in proximal cases.
• Patients with collateral circulation may tolerate extended symptom durations.
• The findings highlight the importance of assessing collateral flow in managing basilar artery thrombosis.