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Case Reports
. 2023 May 9;18(7):2427-2433.
doi: 10.1016/j.radcr.2023.04.010. eCollection 2023 Jul.

Successful thrombectomy of top-of-the-basilar artery occlusion - difficult to detect in clinical practice: A case report

Le Minh Thang  1 , Tran Chi Cuong  1 , Nguyen Dao Nhat Huy  1 , Nguyen Luu Giang  1 , Nguyen Quang Hung  2 , Nguyen Hai Dang  2 , Ton Nu Thi Diem  2 , Nguyen Trung Tinh  2 , Nguyen Minh Duc  3
Affiliations
Case Reports

Successful thrombectomy of top-of-the-basilar artery occlusion - difficult to detect in clinical practice: A case report

Le Minh Thang et al. Radiol Case Rep. .

Abstract

Top-of-the-basilar artery occlusion frequently causes infarction of the midbrain, thalamus, and portions of the temporal and occipital lobes as the vascular supply of these regions comes from the posterior communicating and posterior cerebral arterial tributaries of the basilar artery. Clinical signs include an array of visual, oculomotor, and behavioral abnormalities, usually without prominent motor dysfunction, which makes diagnosis challenging for those inexperienced with these sign. We describe a 59-year-old male presenting with acute ischemic stroke due to top-of-the-basilar artery occlusion. Despite attempting several paraclinical examinations relating the sudden coma with Glasgow Coma Scale of 6 points, the neuroimaging detected the large vessel occlusion that was difficult to recognize. After confirming top-of-the-basilar artery occlusion, the recanalization was realized immediately. The patient was discharged with good clinical recovery.

Keywords: Occlusion; Recanalization; Thrombectomy; Top-of-the-basilar artery.

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Figures

Fig. 1
Fig. 1
Left cerebellar infarction in the PICA-controlled territory (red arrow).
Fig. 2
Fig. 2
Occlusion of the left vertebral artery from the origin (red arrow) and suspicious lesion at the top-of-the-basilar artery (red circle).
Fig. 3
Fig. 3
Cerebellar, occipital lobe (red arrow) and thalamus infarction (red circle) on DWI.
Fig. 4
Fig. 4
Small hypointense signal representing suspected thrombus in the top-of-the-basilar artery (B) in SWI.
Fig. 5
Fig. 5
Angiography showing patent right vertebral artery (A) Contrast filling defect at the top-of-the-basilar artery representing thrombus and absent paramedian thalamic artery perforators (B, C).
Fig. 6
Fig. 6
(A) Sofia Plus intermediate aspiration catheter tip placed at the top-of- the-basilar artery thrombus (red arrow). (B) Thrombus collected by manual aspiration (red circle).
Fig. 7
Fig. 7
The angiogram revealed complete recanalization of the vertebrobasilar artery. (A) Before thrombectomy. (B) After thrombectomy (revascularization of paramedian thalamic artery perforators).
Fig. 8
Fig. 8
MRI showed successful recanalization of the right vertebrobasilar artery.
Fig. 9
Fig. 9
Near-full recovery of the patient 24 hours after neuro-intervention.
See this image and copyright information in PMC

References

    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K. Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30. Erratum in: Stroke. 2019 Dec;50(12):e440-e441. PMID: 31662037. - DOI - PubMed
    1. Merwick Á, Werring D. Posterior circulation ischaemic stroke. BMJ. 2014;348:g3175. doi: 10.1136/bmj.g3175. Erratum in: BMJ. 2014;348:g3773. PMID: 24842277. - DOI - PubMed
    1. Caplan L, Chung CS, Wityk R, Glass T, Tapia J, Pazdera L. New England medical center posterior circulation stroke registry: I. Methods, data base, distribution of brain lesions, stroke mechanisms, and outcomes. J Clin Neurol. 2005;1(1):14–30. doi: 10.3988/jcn.2005.1.1.14. Epub 2005 Apr 30. PMID: 20396469; PMCID: PMC2854928. - DOI - PMC - PubMed
    1. Caplan LR. "Top of the basilar" syndrome. Neurology. 1980;30(1):72–79. doi: 10.1212/wnl.30.1.72. PMID: 7188637. - DOI - PubMed
    1. Weimar C, Goertler M, Harms L, Diener HC. Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia. Arch Neurol. 2006;63(9):1287–1291. doi: 10.1001/archneur.63.9.1287. PMID: 16966507. - DOI - PubMed

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