Anterior-to-posterior circulation approach for mechanical thrombectomy of an acutely occluded basilar artery using the penumbra aspiration system

Abstract

Objective: Prompt access to arterial occlusion is the key to successful endovascular revascularization in acute stroke. We present the first reported case utilizing anterior-to-posterior circulation approach for a successful mechanical thrombectomy and chemical thrombolysis of an acute basilar artery (BA) occlusion using the Penumbra Aspiration System.

Methods: A 39-year-old man with known left vertebral artery (VA) occlusion presented with a rapid progression of top of the basilar syndrome, resulting in a comatose status with flaccid motor exam and no corneal reflex. Navigation of a guide catheter into the right VA was unsuccessful because of an acute angle created by the previously placed right VA ostial stent that herniated into the subclavian artery. Left internal carotid artery-selective angiography revealed a prominent left posterior communicating artery. A Penumbra 026 reperfusion catheter was advanced into the thrombosed BA via the left internal carotid artery, the posterior communicating artery, and the P1 segment. Mechanical thrombectomy and chemical thrombolysis were successfully performed.

Results: TIMI-3 in the BA and TIMI-2 flows in posterior cerebral arteries were restored 8 hours 16 minutes after symptom onset. The patient had recovered full strength in all four extremities at 10 hours after the onset and had a National Institutes of Health Stroke Scale score of 2 at discharge.

Conclusion: In patients with unfavorable VA anatomy, anterior-to-posterior thrombectomy of the BA can be successfully achieved using the Penumbra catheter via an anatomically suitable posterior communicating artery.