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No Superior Treatment for Acute Basilar Artery Occlusion

Last Updated: July 06, 2009.

In patients with acute basilar artery occlusion, intra-arterial therapy is not unequivocally superior to primary intravenous thrombolysis, according to a study published online July 6 in The Lancet Neurology.

MONDAY, July 6 (HealthDay News) -- In patients with acute basilar artery occlusion, intra-arterial therapy (IAT) is not unequivocally superior to primary intravenous thrombolysis (IVT), according to a study published online July 6 in The Lancet Neurology.

Wouter J. Schonewille, M.D., of University Medical Center Utrecht and the Rudolf Magnus Institute of Neurosciences in the Netherlands, and colleagues compared outcomes in 592 patients who received one of three treatments: antithrombotic treatment (AT) only, IVT, or IAT.

After one month, the researchers found that 402 (68 percent) of patients had a poor outcome, which was defined as a modified Rankin scale score of four or five (for severe disability), or death. In patients with a mild-to-moderate deficit, they found that IVT and IAT were associated with a similar risk of poor outcome (adjusted risk ratios, 0.94 and 1.29, respectively), as compared with outcome following AT, but that IAT was associated with worse outcomes compared to IVT (adjusted risk ratio, 1.49). In patients with a severe deficit, they found that, compared with outcome following AT, treatment with either IVT or IAT was associated with a lower risk of poor outcome (adjusted risk ratios, 0.88 and 0.94, respectively), and that outcomes were similar for IAT compared to IVT (adjusted risk ratio, 1.06).

"The often-held assumption that IAT is superior to IVT in patients with an acute symptomatic basilar artery occlusion is challenged by our observations," the authors conclude.

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