Intra-arterial thrombolysis for basilar artery thrombosis and stenting for asymptomatic carotid disease: implications and future directions.

Where knowledge fails controversies thrive. This applies particularly to techniques in evolution. Intra-arterial thrombolysis (IAT) for basilar artery thrombosis and stenting for asymptomatic carotid disease share 3 characteristics: they are operator-dependent, technology-intensive and expensive. Although IAT and stenting imply a similar approach, the clinical problems that they address differ radically. IAT is unscheduled and dramatic, the interventionalist hoping for something to happen, namely recanalization and improvement, whereas stenting for asymptomatic carotid disease is scheduled and undramatic, the interventionalist hopes that nothing happens, either during the procedure, or thereafter (ie, no stroke).