Intravenous tenecteplase for basilar artery occlusion: a case report

There is a paucity of data demonstrating the safety and efficacy of intravenous tenecteplase in patients with acute ischemic stroke in the posterior circulation. Basilar artery occlusion (BAO), resulting from an interruption of blood supply to the vertebrobasilar system of cerebral arteries, is a major cause of severe posterior circulation strokes. A 65-year-old male patient was admitted to the Department of Neurology, Saarland University Medical Center with symptoms of acute ischemic stroke in the posterior circulation. Computed tomography (CT) angiography revealed an acute BAO. The patient was administered intravenous tenecteplase at a dose of 0.25mg/kg. Following the patient’s transfer to the catheterization room for the scheduled endovascular treatment, a notable improvement in symptoms was observed, with an initial National Institutes of Health Stroke Scale (NIHSS) score of 20 decreasing to 2. This substantial improvement precluded the necessity for any catheter intervention. Subsequent control CT angiography demonstrated recanalisation of the BAO after administration of intravenous tenecteplase. No hemorrhagic complications occurred. This case demonstrates that the administration of intravenous tenecteplase at a dose of 0.25mg/kg in patients with BAO can result in successful reperfusion without symptomatic intracranial hemorrhage.