Vertebrobasilar Disease and Thrombolytic Treatment

IN THIS issue of the ARCHIVES, Grond et al¹ report favorable results of treatment in 10 of 12 patients with acute vertebrobasilar territory ischemia given intravenous (IV) recombinant tissue-type plasminogen activator followed with heparin. Physicians have sought desperately during the past half century to find an effective treatment for patients with acute brain ischemia. Thrombolytic treatment is clearly au courant but many questions remain. Which thrombolytic drug should be used, at what dosage, given by which route, to which patients, with what vascular lesions, with what time constraints? What extent, if any, of brain infarction, determined by what technology prior to infusion, contraindicates thrombolysis or provides a major risk for its use? What tests are needed before treatment? Should heparin or any other coagulation-modifying agent or angioplasty be used after thrombolysis and when? The report of Grond et al¹ must be viewed in the context of what is already known about vertebrobasilar ischemia and thrombolytic treatment.