Combined Treatment with Intravenous Abciximab and Intraarterial tPA Yields High Recanalization Rate in Patients with Acute Basilar Artery Occlusion

BACKGROUND: The best therapeutic approach in patients with acute basilar artery occlusion (BAO) remains unclear. We report the results of a combined treatment approach with intravenous (IV) abciximab and intraarterial (IA) tissue plasminogen activator (tPA) in these patients. METHODS: We prospectively studied patients with acute BAO on CT-angiography or MR-angiography. We treated patients with IV abciximab followed by IA thrombolysis with tPA. Primary outcome was partial or complete recanalization according to thrombolysis in myocardial infarction 2 to 3 flow grades on catheter angiography. Secondary outcomes were favorable functional outcome (mRS score ≤3) and mortality at 90 days. RESULTS: Of 20 patients, mean age was 62 ± 13 years, median baseline National Institutes of Health Stroke Scale (NIHSS) score 25.5 (IQR 12-28), and median Glasgow Coma Scale score 7 (IQR 6-11). Mean time to IA treatment was 7 ± 2.8 hours. We achieved partial or complete recanalization in 17/20 patients (85%). At 3 months, 3/20 patients (15%) had a favorable functional outcome and 9/20 patients (45%) were deceased. CONCLUSIONS: Combined treatment with IV abciximab and IA tPA yielded a high recanalization rate in patients with BAO. However, functional outcomes were poor, potentially due to late initiation of treatment. Early treatment might improve functional outcome.