Case Report: Four Early Recurrent Basilar Artery Occlusions Successfully Treated With Mechanical Thrombectomy and Subsequent Vertebral Artery Coil Occlusion

Abstract

We present the case of a middle-aged patient who had four recurrent acute basilar artery occlusions over a period of 3 months, each time successfully treated with mechanical thrombectomy. Extensive stroke work-up showed no obvious stroke etiology aside from a dysplastic right vertebral artery with multifocal stenoses. Treatment with different antiplatelet and anticoagulant regimes did not prevent basilar artery occlusion recurrence. Therefore, transarterial coil occlusion of the V4-segment of the right vertebral artery was performed as ultima ratio without complications. At final discharge, the patient had no persistent neurological deficits. No further cerebrovascular events occurred over a 12-month follow-up period.

Bony Stroke: Ischemic Stroke Caused by Mechanical Stress on Brain Supplying Arteries From Anatomical Bone or Cartilage Anomalies

“…Described treatment options are diverse and include conservative treatment, endovascular stenting, occlusion of the affected vessel, surgical bypass, and bone/cartilage removal. 2–5,7–10,13,17–19…”

“…Described treatment options are diverse and include conservative treatment, endovascular stenting, occlusion of the affected vessel, surgical bypass, and bone/cartilage removal. [2][3][4][5][7][8][9][10]13,[17][18][19] To raise awareness for bony strokes and to improve treatment of patients, we retrospectively describe the diagnostic workup and therapeutic options of patients with ischemic strokes due to bone or cartilage anomalies at our comprehensive stroke care center.…”

“…Mainly, single case reports or small case series have been reported. 3–5,7–10,13,17–19 A systematic retrospective literature analysis has twice been performed for the Bow Hunter`s syndrome, reporting 153 and 194 patients respectively. 2,15…”

“…Mainly, single case reports or small case series have been reported. [3][4][5][7][8][9][10]13,[17][18][19] A systematic retrospective literature analysis has twice been performed for the Bow Hunter`s syndrome, reporting 153 and 194 patients respectively. 2,15 Diagnosis of a bony stroke is based on a combination of imaging devices including computed tomography (CT), magnetic resonance imaging (MRI) angiography, and sonography of brain supplying vessels.…”

“…9,10 Lastly, anomalies of vertebra or the occiput may cause the formation of pseudoaneurysms or a vascular stenosis of the VA constituting a possible source of embolism in the posterior circulation. [11][12][13] Among these, a compressive VA affection triggered by head rotation to the contralateral side is called Bow Hunter syndrome. 2,[14][15][16] Uniting these ischemic strokes caused by mechanical stress on brain supplying arteries, we established the term bony stroke.…”