Late recanalization of basilar artery occlusion in a previously healthy 17-month-old child

Abstract

Endovascular treatment of acute ischemic stroke in children is increasingly being reported, although the time window for intervention is unclear. We describe a previously healthy 17-month-old child who presented with vertebral artery thrombosis and cerebellar stroke requiring posterior fossa decompression. She later progressed to basilar artery thrombosis treated with mechanical thrombectomy 50 hours after clinical decline. At 3 month follow-up, the patient had a modified Rankin Scale score of 0.

Keywords: intervention; pediatrics; stroke; thrombectomy.

Figure 1

(A) MR angiography (MRA) at presentation shows a left vertebral occlusion (asterisk) with patent right vertebral and basilar arteries. (B) Superior, (C) middle, and (D) inferior axial diffusion-weighted images show multiple areas of acute ischemia (arrows) within the thalamus, splenium of the corpus callosum, cerebellum, and medulla.

Figure 2

(A) MR angiography (MRA) 46 hours after first MRA shows occlusion of the basilar artery (asterisk). (B) Superior, (C) middle, and (D) inferior axial diffusion-weighted images with progression of the prior areas of ischemia (arrows).

Figure 3

Angiography/mechanical thrombectomy at 50 hours after last known normal. (A) Lateral right common carotid angiogram shows filling of the right posterior cerebral artery through the posterior communicating artery. (B) Anteroposterior (AP) right vertebral angiogram shows occlusion of the basilar artery. (C) Spot AP fluoroscopy image shows the Solitaire stent-retriever in the basilar artery. (D) Post-first pass AP right vertebral angiogram shows a filling defect at the top of balloon-guide catheter. (E) Repeat AP angiography after negative aspiration of balloon guide shows a widely patent basilar artery with a filling defect at the top of the basilar artery extending into the right P1 segment. (F) Final AP right vertebral angiogram shows a widely patent basilar artery and both posterior cerebral arteries with a small filling defect in a distal right posterior cerebral artery branch (TICI 2b reperfusion).

Figure 4

MR angiography (MRA) 3 months after thrombectomy shows a widely patent right vertebral artery, basilar artery, and bilateral posterior cerebral arteries, with persistent occluded left vertebral artery (asterisk).