Isolated Focal Basilar Artery Stenosis with Acute Stroke Treated with Emergency Thrombectomy and Stenting

Abstract

Strokes due to basilar artery (BA) stenosis/occlusion are devastating. As it is an uncommon cause of stroke, its optimal management is not clearly defined. We present the case of a 68-year-old male with a background history of hypertension, hyperlipidaemia, and smoking who developed a sudden onset of reduced consciousness, myoclonic jerks, generalised weakness, and nausea due to an occluded mid-segment BA with right occipital and left cerebellar infarcts. Emergent cerebral angiography was performed and he was immediately treated by clot retrieval and, due to underlying arterial stenosis, the immediate placement of a stent within 3 h of symptom onset. He had complete neurological recovery within 1 week, with no neurological deficits. He remained well at follow-up 3 months later. Emergency revascularisation of stroke due to BA occlusion should be considered as a treatment option.

The Role of Transcranial-Color-Doppler in the Management of Basilar Artery Stenosis: Case Series and Systematic Review of Literature

“…The potential complications associated with this treatment option include periprocedural risks of ischemia, hemorrhage, intimal dissection, postoperative neurological deficits, and the possibility of in-stent restenosis [13,17,26,27]. Moreover, there is the risk of BA branch occlusion due to the "snow ploughing" effect (displacing plaque into branch/perforating arteries during the process of stent deployment) in branches such as the anterior inferior cerebellar artery or the pontine arteries [28]. In a recent study investigating angiographic and clinical differences in BAO subtypes undergoing mechanical thrombectomy, despite comparable rates of successful recanalization, outcome of the treatment seemed to depend on pathogenesis with less clinical benefit for underlying BAS, raising the question of early identification of this subgroup [29].…”