Basilar Artery Occlusion (BAO) revascularization after more than 12 hours from the onset of symptoms with excellent outcome: Report of a case

Abstract

This paper reports a case of basilar artery occlusion (BAO), a relatively rare event associated with high mortality rate and high risk of disability. A 77-year-old man arrived at our Stroke Unit approximately 14 hours after the onset of symptoms (dysarthria and complete left hemiparesis) with progressive worsening up to coma and with a National Institute Health Stroke Scale (NIHSS) of 22. The patient was treated and, at discharge, the modified Rankin scale and NIHSS were 2 and 5, respectively. The aim of this paper is to illustrate how revascularization treatment, also after 12 hours, could be a viable option to ensure survival and a good life quality for the patient. Furthermore, it is essential to encourage the publication of a greater number of trials about the posterior circulation emphasizing how many favorable prognosis indicators are now recognized.

Keywords: Basilar artery occlusion; Interventional neuroradiology; Neuroradiology; Revascularization; Stroke.

Fig. 1

CT examination excludes the presence of hemorrhagic areas and reveals the presence of spontaneously hyperdensity of the basilar artery.

Fig. 2

First angiogram from RVA showing occlusion of basilar artery before its bifurcation. Initial angiogram demonstrating occlusion of the basilar artery beyond the PICA.

Fig. 3

TICI III complete revascularization of posterior cerebral artery after aspiration with 4MAX catheter.

Fig. 4

Post-procedural dynaCT demonstrating hyperperfusion in pontine and left thalamic regions.

Fig. 5

Hemosiderinic deposit in left thalamus as small post-thrombectomy reperfusion injury.