title: Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature.
abstract: BACKGROUND
  Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents.
  
  
  METHODS
  We report the case of a 23-month old baby that came to the emergency room of our hospital for progressive impairment of consciousness associated with widespread stiffness and plaintive cry, appeared after accidental fall from stroller. An emergency brain CT scan was obtained showing multiple infarction lesions in the brainstem and left cerebellum suggestive of acute stroke in posterior circulation territories. An MR scan with angiography and diffusion-weighted sequences confirmed the multiple infarction lesions and demonstrated poor representation of the flow signal at the V3 segment of the left vertebral artery and absent representation of the flow signal at the distal segment of the basilar artery suggestive of acute thrombotic occlusion. The patient was immediately referred to interventional neuroradiology unit, and digital subtraction angiography showed complete basilar artery occlusion and left vertebral artery dissection at extracranial V2-V3 segment. The patient underwent intra-arterial thrombectomy using stent retrievers and occlusion of the V2-V3 segment of the left vertebral artery. The patient survived and long-term outcome was excellent.
  
  
  CONCLUSIONS
  To our knowledge, only nine cases of ABAO in children treated with intra-arterial thrombectomy have been previously reported in the literature. In only three cases, the Solitaire stent was applied. Our case is the first case of basilar artery occlusion treated with Solitaire stent, in a child under 24 months. The reports that are available so far indicate that basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents.
authors.affiliation: Department of Neurosurgery, Santobono- Pausillipon Children's Hospital, Naples, Italy.|Department of Health Sciences, University of L'Aquila, L'Aquila, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Nicosia
authors.affiliation: Paediatric Neuroradiology Unit, Santobono- Pausillipon Children's Hospital, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Cicala
authors.affiliation: Department of Neurosurgery, Santobono- Pausillipon Children's Hospital, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mirone
authors.affiliation: Department of Neurosurgery, Santobono- Pausillipon Children's Hospital, Naples, Italy. pierospen@gmail.com.
authors.forename: Pietro
authors.initials: P
authors.lastname: Spennato
authors.affiliation: Department of Neurosurgery, Santobono- Pausillipon Children's Hospital, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Trischitta
authors.affiliation: Department of Neurosurgery, Santobono- Pausillipon Children's Hospital, Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ruggiero
authors.affiliation: Diagnostic and Interventional Neuroradiology Unit, AORN Cardarelli Hospital, Naples, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Guarneri
authors.affiliation: Diagnostic and Interventional Neuroradiology Unit, AORN Cardarelli Hospital, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Muto
authors.affiliation: Department of Neurosurgery, Santobono- Pausillipon Children's Hospital, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cinalli
mesh_terms: D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D057510:Endovascular Procedures; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endovascular treatment; Ischemic stroke; Paediatric stroke; Stent retrievers; Vertebral artery dissection