Sequential combination of two intravenous thrombolytics (recombinant tissue plasminogen activator/tenecteplase) in a patient with stroke and cardioembolic basilar artery occlusion

J Stroke Cerebrovasc Dis. 2009 Jan;18(1):68-71. doi: 10.1016/j.jstrokecerebrovasdis.2008.08.001.

Abstract

Stroke caused by acute occlusion of basilar artery (AOBA) produces high risk of death. In eligible patients, thrombolysis significantly reduces mortality and disability rate. In most hospitals, thrombolysis is limited to intravenous (IV) route of recombinant tissue plasminogen activator, without any therapeutic alternative in cases of treatment failure. We report a case of cardioembolic AOBA, not responsive to a conventional regimen of IV recombinant tissue plasminogen activator. A sequential combination of IV tenecteplase (0.4 mg/kg) led to a complete recanalization of basilar artery, with a very good clinical outcome. The potential for a combination of two successive IV regimens should be evaluated in AOBA.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Diffusion Magnetic Resonance Imaging
  • Drug Therapy, Combination
  • Embolism / complications*
  • Embolism / drug therapy
  • Embolism / pathology
  • Fibrinolytic Agents / administration & dosage*
  • Heart Diseases / complications*
  • Heart Diseases / drug therapy
  • Heart Diseases / pathology
  • Humans
  • Infusions, Intravenous
  • Magnetic Resonance Angiography
  • Male
  • Recombinant Proteins / administration & dosage
  • Stroke / drug therapy*
  • Stroke / etiology
  • Stroke / pathology
  • Tenecteplase
  • Thrombolytic Therapy*
  • Tissue Plasminogen Activator / administration & dosage*
  • Treatment Outcome
  • Vertebrobasilar Insufficiency / drug therapy*
  • Vertebrobasilar Insufficiency / etiology
  • Vertebrobasilar Insufficiency / pathology

Substances

  • Fibrinolytic Agents
  • Recombinant Proteins
  • Tissue Plasminogen Activator
  • Tenecteplase