Endovascular revascularization for basilar artery occlusion

Abstract

Basilar artery occlusion is one of the most devastating neurological conditions known to man. Though rare, patients with clinical syndromes localized to this anatomical region are often referred to acute stroke and endovascular units. Recent studies evaluating the efficacy of endovascular approaches to stroke have focused on anterior circulation syndromes. In this review, we examine the approaches to stroke syndromes due to basilar artery thrombosis. We share the relevant data for intravenous and intra-arterial tissue plasminogen activator as well as mechanical approaches to restoring perfusion in this critical area of the brain.

Keywords: Basilar artery occlusion; Endovascular revascularization.

Figures

Fig. 1

A 63-year-old female with a history of atrial fibrillation, but not anticoagulated, presented with 24 h of ophthalmoplegia, dysarthria, dysmetria, and a fluctuating level of consciousness. A head CT demonstrated an acute right cerebellar stroke and multiple old strokes in the bilateral occipital lobes and left thalamus. The Penumbra Stroke System was successfully used to remove the clot in her basilar artery and achieve complete revascularization.

Fig. 2

A 54-year-old man with hypertension and dyslipidemia presented with nausea and vomiting, fluctuating left-sided weakness, and a fluctuating level of consciousness. A CT angiography demonstrated midbasilar occlusion, likely representing atherosclerotic disease. A Solitaire revascularization device was deployed across the basilar occlusion into the left posterior cerebral artery. Retrieval of the device resulted in complete revascularization of the basilar artery and its distal territories. A focal, severe, midbasilar stenosis was now demonstrable. This was successfully treated by angioplasty alone, using a Gateway PTA Balloon Catheter. A decision was made not to stent the vessel at this time, given the need for acetylsalicylic acid/Plavix in the context of an acute stroke syndrome.