Skip to main content
SpringerLink
Log in

Basilar artery occlusion

  • Review
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Basilar artery occlusion is assumed to carry a grave prognosis, with mortality rates of up to 90%. Diagnosis is often delayed, or even missed, as a result of the variety of clinical presentations seen with this condition. The pathogenesis of occlusion can be secondary to both local atherothrombosis or cardioembolism. The use of noninvasive imaging such as magnetic resonance imaging and computed tomography angiography has improved recognition of clinical syndromes associated with occlusion. Although no randomized studies have been performed, recanalization of the vascular occlusion, particularly with thrombolytic agents, appears to result in improved outcomes in selected patients. However, the optimum timing for therapy is unclear, and reperfusion therapy may need to be combined with definitive vascular treatment of underlying vascular stenosis. Increasing awareness of this condition may reveal the natural history to be more diverse than previously recognized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Turney TM, Garraway WM, Whisnant JP. The natural history of hemispheric and brainstem infarction in Rochester, Minnesota. Stroke 1984;15:790–794.

    CAS  Google Scholar 

  2. Caplan L. Vertebrobasilar disease and thrombolytic treatment. Archives Neurol 1998;55(4):450–451.

    Article  CAS  Google Scholar 

  3. Hornig CR, Lammers C, Buttner T, Hoffman O, Dorndorf W. Long-term prognosis of infratentorial transient ischemic attacks and minor stroke. Stroke 1992;23:199–204.

    PubMed  CAS  Google Scholar 

  4. Leyden E. Ueber die Thrombose der Basilar-Arterie. Ztscher Klin Med 1882;69:73–121.

    Google Scholar 

  5. Kubrik CS, Adams RA. Occlusion of the basilar artery—a clinical and pathological study. Brain 1946;69:73–121.

    Article  Google Scholar 

  6. Biemond A. Thrombosis of the basialr artery and vascularisation of the brainstem. Brain 1951;74:300–317.

    Article  PubMed  CAS  Google Scholar 

  7. Haugstead H. Occlusion of the basilar artery: diagnosis by vertebral angiography during life. Neurology 1956;6:823–828.

    Google Scholar 

  8. Fields WS, Ratinov G, Weibel J, Campos RJ. Survival following basilar artery occlusion. Arch Neurol 1966;15(5):463–471.

    PubMed  CAS  Google Scholar 

  9. Devuyst G, Bogousslavsky J, Meuli R, Moncayo J, De Freitas G, Van Melle G. Stroke or transient ischemic attacks with basilar artery stenosis or occlusion. Arch Neurol 2002;59:567–573.

    Article  PubMed  CAS  Google Scholar 

  10. Caplan L. Occlusion of the vertebral or basilar artery. Follow up of some patients with benign outcome. Stroke 1979;10(3):277–282.

    PubMed  CAS  Google Scholar 

  11. Little JR, Furlan AJ. Resolving occlusive lesions of the basialr artery. Neurosurgery 1985;17(5):811–814.

    Article  PubMed  CAS  Google Scholar 

  12. Chan DK, Silver FL. Basilar artery stenosis mimicking the lacunar syndrome of pure motor hemiparesis. Canadian J Neurol Sciences 2003; 30(2):159–162.

    Google Scholar 

  13. Brandt T, Pessin MS, Kwan ES, Caplan LR. Survival with basilar artery occlusion. Cerebrovasc Dis 1995;5:182–187.

    Google Scholar 

  14. Archer CR, Horenstein S. Basilar artery occlusion. Stroke 1977;8(3):383–391.

    PubMed  CAS  Google Scholar 

  15. Fisher CM, Gore I, Okabe N, White PD. Atherosclerosis of the carotid and vertebral arteries—extracranial and intracranial. J Neuropathol Exp Neurol 1965;24:455–476.

    Google Scholar 

  16. Thompson JR, Simmons CR, Hasso AN, Hinshaw DBJ. Occlusions of the intradural vertebrobasilar artery. Neuroradiology 1978;14:219–229.

    Article  PubMed  CAS  Google Scholar 

  17. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H. Arterial territories of human brain: brainstem and cerebellum. Neurology 1996;47(5):1125–1135.

    PubMed  CAS  Google Scholar 

  18. Fisher CM. Cerebral ischemia—less familiar types. Clin Neurosurg 1965;18:267–336.

    Google Scholar 

  19. Liebeskind D. Collateral circulation. Stroke 2003;34:2279.

    Article  PubMed  Google Scholar 

  20. Bogousslavsky J, Regli F, Maeder P, Meuli R, Nader J. The eitiology of posterior circulation infarcts: a prospective study using magnetic resonance imaging and magnetic resonance angiography. Neurology 1993;43(8):1528–1533.

    PubMed  CAS  Google Scholar 

  21. Caplan L. Posterior circulation ischemia: then, now and tomorrow. Stroke 2000;31:2011–2023.

    PubMed  CAS  Google Scholar 

  22. Schwarz S, Egelhof T, Schwab S, Hacke W. Basilar artery embolism. Clinical syndrome and neuroradiological patterns without permanent occlusion of the basilar artery. Neurology 1997;49(5): 1346–1352.

    PubMed  CAS  Google Scholar 

  23. Moncayo J, Bogousslavsky J. Vertebro-basilar syndromes causing oculo-motor disorders. Curr Opin Neurol 2003;16(1):45–50.

    Article  PubMed  Google Scholar 

  24. Levy EI, Firlik AD, Wisniewski S, et al. Factors affecting survival rates for acute vertebrobasilar atrery occlusions treated with intra-arterial thrombolytic therapy: a meta-analytical approach. Neurosurgery 1999;45:539–545.

    Article  PubMed  CAS  Google Scholar 

  25. Gorelick PB, Caplan L, Hier DB, et al. Racial differences in the distribution of posterior circulation disease. Stroke 1985;16(5):785–790.

    PubMed  CAS  Google Scholar 

  26. Ferbert A, Bruckmann H, Drummen R. Clinical features of proven basilar artery occlusion. Stroke 1990;21:1135–1142.

    PubMed  CAS  Google Scholar 

  27. Koennecke HC, Mast H, Trocio SSJ, Sacco RL, Thompson JL, Mohr JP. Microemboli in patients with vertebrobasilar ischemia: association with vertebrobasilar and cardiac lesions. Stroke 1997;28(3):593–596.

    PubMed  CAS  Google Scholar 

  28. Becker KJ, Monsein LH, Ulatowski J, Mirski M, Williams M, Hanlet DF. Intraarterial thrombolysis in vertebrobasilar occlusion. Amer J Neuroradiol 1996;17:255–262.

    CAS  Google Scholar 

  29. De Witte TC, Moran CJ, Atkins PT, Angtuaco EE, Diringer MN. Relationship between clot location and outcome after basilar artery thrombolysis. Amer J Neuroradiol 1997;18:1221–1228.

    Google Scholar 

  30. Caplan L. “Top of the Basilar” syndrome. Neurology 1980;30(1):72–79.

    PubMed  CAS  Google Scholar 

  31. Libman R, Benson R, Einberg K. Myasthenia mimicking vertebrobasilar stroke. J Neurol 2002;249(11):1512–1514.

    Article  PubMed  Google Scholar 

  32. Saposnik G, Caplan LR. Convulsive-like movements in brainstem stroke. Arch Neurol 2001;58:654–657.

    Article  PubMed  CAS  Google Scholar 

  33. Bonafe A, Manelfe C, Scotto B, Pradere MY, Rascol A. Role of computerised tomography in vertebrobasilar ischemia. Neuroradiology 1985;27(6):484–493.

    Article  PubMed  CAS  Google Scholar 

  34. Brandt T, Knauth M, Wildermuth S, et al. CT angiography and doppler sonography for emergency assessment in acute basilar artery ischaemia. Stroke 1999;30:606–612.

    PubMed  CAS  Google Scholar 

  35. Davis SM. Magnetic resonance imaging in posterior circulation infarcion: impact in daignosis and management. Aust N Z J Med 1989;19:219–225.

    PubMed  CAS  Google Scholar 

  36. Linfante I, Linas RH, Schlaug G, Chaves C, Warach S, Caplan L. Diffusion weighted imaging and National Institutes of Health Stroke Scale in the acute phase of posterior circulation stroke. Arch Neurol 2001;58:621–628.

    Article  PubMed  CAS  Google Scholar 

  37. du Mesial de Rochemont R, Neumann-Haefelin T, Berkefeld J, Sitzer M, Lanfermann H. Magnetic resonance imaging in basilar artery occlusion. Arch Neurol 2002;59:398–402.

    Article  Google Scholar 

  38. Bhadelia RA, Bengoa F, Gesnor L, Patel SK, Uzun G, Wolpert SM. Efficacy of MR angiography in the detection and characterisation of occlusive disease in the vertebrobasilar system. J Comput Assist Tomogr 2001;25:458–465.

    Article  PubMed  CAS  Google Scholar 

  39. Oppenheim C, Stanescu R, Dormont D, et al. False negative diffusion weighted MRI in acute ischemic stroke. Amer J Neuroradiol 2000;21(8):1434–1440.

    CAS  Google Scholar 

  40. Hanley DF. Review of critical care and emergency approaches to stroke. Stroke 2003;34: 342–364.

    Article  Google Scholar 

  41. Brandt T, Von Kummer R, Muller-Kuppers M, Hacke W. Thrombolytic therapy of acute basilar artery occlusion. Stroke 1996;27:875–881.

    PubMed  CAS  Google Scholar 

  42. Wijdicks EFM, Scott JP. Outcome in patients with basilar acute artery occlusion requiring mechanical ventilation. Stroke 1996;27(8):1301–1303.

    PubMed  CAS  Google Scholar 

  43. Sliwka U, Mull M, Stelzer A, Diehl R, Noth J. Long term follow-up of patients after intrarterial thrombolytic therapy of acute vertebrobasilar artery occlusion. Cerebrovasc Dis 2001;12(3):214–219.

    Article  PubMed  CAS  Google Scholar 

  44. Berg-Dammer E, Felber SR, Henkes H, Nahser HC, Kuhne D. Long-term outcome after local intra-arterial fibrinolysis of basilar artery thrombosis. Cerebrovascular Diseases 2000;10:183–188.

    Article  PubMed  CAS  Google Scholar 

  45. Qureshi AI, Ziai WC, Yahia AM, et al. Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: a multicenter study. Neurosurgery 2003;52(5):1033–1039.

    Article  PubMed  Google Scholar 

  46. Group TW-ASIDWs. Prognosis of patients with symptomatic vertebral or basilar artery stenosis. Stroke 1998;29(7):1389–1392.

    Google Scholar 

  47. Siekert RG, Millikan CH. Studies in cerebrovascular disease. II. Some aspects of thrombosis of the basilar artery. Proceed Staff Meet Mayo Clin 1955;30:93–100.

    CAS  Google Scholar 

  48. Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 1988;19(10):1216–1222.

    PubMed  CAS  Google Scholar 

  49. Duke RJ, Turpie AG, Trebilcock R, Bayer N. Intravenous heparin for the prevention of stroke progression in acute partial stable stroke. Ann Intern Med 1986;105:825–828.

    PubMed  CAS  Google Scholar 

  50. Donnan GA, Davis SM. Heparin in stroke: not for most but the controversy lingers. Stroke 2002;34:232–233.

    Article  Google Scholar 

  51. Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial. Stroke 1997;28:2119–2125.

    Google Scholar 

  52. Davis SM,G.A.D, Gerraty RP. Australian Urokinase Stroke Trial. Cerebrovasc Dis 1996;6:188.

    Google Scholar 

  53. Zeumer H, Freitag HJ, Zanella F, Thie A, Aming C. Local intra-arterial fibrinolytic therapy in patients with acute stroke: urokinase versus recombinant tissue plasminogen activator (r-tPA). Neuroradiology 1993;34:561–571.

    Google Scholar 

  54. Cross DT, Moran CIJ, Atkins PT et al. Relationship between clot location and outcome after basilar artery thrombolysis. Amer J Neuroradiol 1997;18:1221–1228.

    Google Scholar 

  55. Wijdicks EFM, Nichols DA, Thielen KR, et al. Intra-arterial thrombolysis in acute basilar artery thromboembolism: the initial mayo clinic experience. Mayo Clinic Proceed 1997;72(11): 1005–1013.

    CAS  Google Scholar 

  56. Lisboa RC, Jovanovic BD, Alberts MJ. Analysis of the safety and efficacy of intra-arterial thrombolytic therapy in ischemic stroke. Stroke 2002;33:2866–2871.

    Article  PubMed  CAS  Google Scholar 

  57. Mayer TE, Hamann GF, Brueckmann HJ. Treatment of basilar artery embolism with a mechanical extraction device: necessity of flow reversal. Stroke 2002;33:2232–2235.

    Article  PubMed  Google Scholar 

  58. Katzan IL, Furlan AJ. Thrombolytic therapy. In: Current Review of Cerebrovascular Disease. (Fisher M, Bogoresslansky, eds.). Current Medicine LLC, Philadelphia, PA, 2000, pp. 207–215.

    Google Scholar 

  59. Gash AK, Spann JF, Sherry Sea. Factors influencing reocclusion after coronart thrombolysis for acute myocardial infarction. Amer J Cardiol 1986;57:175–177.

    Article  PubMed  CAS  Google Scholar 

  60. Freitag HJ, Becker VU, Thie A, et al. Lys-plasminogen as an adjunct to local intra-arterial fibrinolysis for carotid artery stroke: laboratory and clinical findings. Neuroradiology 1996;38: 181–185.

    PubMed  CAS  Google Scholar 

  61. Antman EM, Giugliano RP, Gibson CM, et al. Abciximab facilitates the rate and extent of thrombolysis: results of the thrombolysis in myocardial infarction (TIMI) 14 trial. Circulation 1999;99:2270–2732.

    Google Scholar 

  62. Adams HPftAi. Effects of abciximaAbciximab in emergent stroke treatment (AbESTT). 28th International Stroke Conference 2003.

  63. Spreer J, Els T, Hetzel A, et al. Primary stenting as emergency therapy in acute basilar artery occlusion. Neuroradiology 2002;44(9):791–795.

    Article  PubMed  Google Scholar 

  64. Gress GR, Smith WS, Dowd CF, Van Halback V, Finlay RJ, Higashida RT. Angioplasty for inracranial symptoms. Neurosurgery 2002;51:23–29.

    Article  PubMed  Google Scholar 

  65. Vallée J-N, Crozier S, Guillevin R, et al. Acute basilar artery occlusion treated by thromboaspiration in a cocaine and ecstasy abuser. Neurology 2003;61:839–841.

    PubMed  Google Scholar 

  66. Zeumer H, Hacke W, Ringelstein EB. Local intrarterial thrombolysis in vertebrobasilar thromboembolic disease. Amer J Neuroradiol 1983;4(3): 401–404.

    CAS  Google Scholar 

  67. Bockenheimer S, Reinhuber F, Mohs C. Intraarterialle thromblyse himversorgender Gefase. Radiologe 1991;31:210–215.

    PubMed  CAS  Google Scholar 

  68. Becker KJ, Purcell LL, Hacke W, Hanley DF. Vertebrobasilar thrombosis: Diagnosis, management, and the use of intra-arterial thrombolytics. Crit Care Med 1996;24(10):1729–1742.

    Article  PubMed  CAS  Google Scholar 

  69. Arnold M, Nedeltchev K, Baumgartner RW, et al. Clinical and radiological predictors of recanalization and outcome in 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis. J Neurol Neurosurg Psychiatry 2004;75:857–862.

    Article  PubMed  CAS  Google Scholar 

  70. Nenci GG, Gresele P, Tamarelli M. Thrombolytic therapy for thromboembolism of the vertebrobasilar artery. Angiology 1983;34:561–571.

    PubMed  CAS  Google Scholar 

  71. Wildemann B, Hutschenreuter M, Kreiger D, et al. Infusion of recombinent tissue plasminogen activator for treatment of acute basilar occlusion. Stroke 1990;21:1513–1514.

    PubMed  CAS  Google Scholar 

  72. Herderschee D, Limberg M, Hijdra A, et al. Recombinent tissue plasminogen activator in two patients with basilar artery occlusion. J Neurol, Neurosurg Psychiatr 1991;54:71–73.

    Article  CAS  Google Scholar 

  73. Heumer M, Niederwieser V, Ladurner G. Thrombolytic treatment for acute occlusion of the basilar artery. J Neurol, Neurosurg Psychiatr 1995;58:227–228.

    Google Scholar 

  74. Grond M, Rudolf J, Schmulling S, Stenzel C, Neveling M, Heiss WD. Early intravenous thrombolysis with recombinent tissue type plasminogen activator in vertebrobasilar ischemic stroke. Arch Neurol 1998;55(4):466–469.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, G51 4TF, Glasgow, Scotland, U.K.

    Tracey A. Baird, Keith W. Muir &  Ian Bone

Authors
  1. Tracey A. Baird
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keith W. Muir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian Bone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ian Bone.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baird, T.A., Muir, K.W. & Bone, I. Basilar artery occlusion. Neurocrit Care 1, 319–329 (2004). https://doi.org/10.1385/NCC:1:3:319

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1385/NCC:1:3:319

Key Words

Search

Navigation