title: Direct Microsurgical Embolectomy for an Acute Distal Basilar Artery Occlusion.
abstract: BACKGROUND
  Acute basilar artery occlusion is associated with high mortality rates, up to 35%-40%. Early revascularization by intravenous thrombolysis, intra-arterial thrombolysis, and endovascular mechanical embolectomy is considered the best option to date. The objective of this technical report is to present the direct microsurgical embolectomy technique for an acute distal basilar artery occlusion as an urgent life-saving revascularization procedure.
  
  
  METHODS
  A 71-year-old male patient suffered from an acute embolic basilar artery occlusion and became unconscious (Glasgow Coma Scale 4). Computed tomography angiography and MRA revealed the distal basilar artery occlusion along with an increased diffusion-weighted imaging signal in the corresponding territory. After an individual case discussion, the patient underwent a microsurgical embolectomy via a frontotemporal craniotomy and an anterior temporal approach.
  
  
  RESULTS
  Intraoperative indocyanine green and postoperative computed tomography angiography revealed complete revascularization of the previously occluded basilar quadfurcation. The patient steadily recovered and was able to walk with assistance after 4 weeks.
  
  
  CONCLUSIONS
  Microsurgical embolectomy can be an effective treatment option for acute distal basilar artery occlusion in selected cases with experienced surgeons, but a critical preoperative decision-making process is needed.
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan; Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany. Electronic address: fgoehre@gmail.com.
authors.forename: Felix
authors.initials: F
authors.lastname: Goehre
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yanagisawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Nakao
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Tarik F
authors.initials: TF
authors.lastname: Ibrahim
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Hugo
authors.initials: H
authors.lastname: Andrade-Barazarte
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ludtka
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
mesh_terms: D000208:Acute Disease; D000368:Aged; D001488:Basilar Artery; D003399:Craniotomy; D017128:Embolectomy / Q000379:methods*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*
keywords: Basilar artery; Basilar artery occlusion; Embolectomy; Ischemic stroke; Posterior circulation