Successful intra-arterial basilar artery thrombolysis in a patient with bilateral vertebral artery occlusion: technical case report.
OBJECTIVE
Basilar artery occlusion is a clinical event with an exceedingly high mortality rate. Improved survival is closely associated with successful recanalization of the occluded basilar artery. Bilateral vertebral artery occlusion (BVAO) is a unique disease entity that effectively denies any direct access to the basilar artery for endovascular rescue therapy. We report a case of successful intra-arterial basilar artery thrombolysis in a patient with BVAO.


METHODS
A 78-year-old man was transferred to our hospital after intravenous administration of tissue plasminogen activator and with deteriorating neurological status requiring intubation. His clinical presentation was highly suggestive of acute basilar artery thrombosis. The cerebral angiogram showed a BVAO and collateral flow reconstituting both distal extracranial vertebral arteries but with significant contrast stasis. There was no retrograde filling of the basilar artery through the only angiographically visible posterior communicating artery.


METHODS
Selective catheterizations of the left occipital artery and the left ascending cervical branch of the thyrocervical trunk were performed to deliver a total of 12 mg of tissue plasminogen activator. At that point, the patient showed significant neurological improvement. The post-tissue plasminogen activator angiogram showed improved flow through the basilar artery. The patient was independent and well at his 1-year follow-up visit.


CONCLUSIONS
Knowledge of potential collateral pathways is important when direct access to the main intracranial vessels is not available. Basilar artery thrombolysis through collateral vessels is clinically effective when a direct approach to the artery is not feasible.
Wang
Huan
H
Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine, Peoria, Illinois, USA.
Fraser
Kenneth
K
Wang
David
D
Alvernia
Jorge
J
Lanzino
Giuseppe
G
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D001488:Basilar Artery / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods*; D007275:Injections, Intravenous / Q000009:adverse effects; D008297:Male; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
D010959:Tissue Plasminogen Activator