Time window for recanalization in basilar artery occlusion: Speculative synthesis.

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

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Mattle, Heinrich and Schroth, Gerhard

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

14 Jan 2016 11:30

Last Modified:

18 Nov 2016 02:30

Publisher DOI:

10.1212/WNL.0000000000002129

PubMed ID:

26574535

BORIS DOI:

10.7892/boris.74572

URI:

https://boris.unibe.ch/id/eprint/74572

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