Cor Vasa 2016, 58(2):e287-e291 | DOI: 10.1016/j.crvasa.2016.01.014

A case of successful interventional treatment in acute basilar artery occlusion

Ivo Petrov^*, Marko Klissurski, Sevim Halibryam, Galina Georgieva-Kozarova, Vesela Stoynova

City Clinic Cardiology Center University Hospital, 127 Okolovrasten pat Street, 1407 Sofia, Bulgaria

We describe a case of successful recanalisation and favorite clinical outcome of a patient with acute basilar artery occlusion (BAO) and interventional treatment (IT). A 67-year old patient presented in a comatose state, with quadriplegia, and decerebrate posturing. His initial Glasgow-Liege Coma Scale (GLCS) score was 11, Institutes of Health Stroke Scale (NIHSS) 24, and modified Rankin Scale (mRS) 5. Non-contrast CT was performed before IT. Due to suspicion of BAO, an immediate cerebral angiography was performed. It demonstrated BAO in the middle and distal segment. Intra-arterial catheter based treatment was performed including balloon angioplasty and thrombolysis with 20 mg Actilyse (within four hours of symptoms onset). An optimal angiographic result was achieved. After the procedure the patient was treated in ICU with another 10 mg Actilyse infused over the next 3 hours. Because of neurological condition improving, the patient was extubated 12 hours later. On the first day, he regained consciousness, being able to speak, without new neurologic deficit. Control CT did not demonstrate new signs of ischemic stroke. CT angiography showed complete basilar artery recanalization in the distal part and a moderate residual stenosis in the middle segment. On the 7th day the patient was discharged with NIHSS 7, GLCS 20, mRS 3. We believe that the success in our case was a result of the prompt clinical diagnosis, fast access to the cathlab and early mechanical-pharmacological recanalization.

Keywords: Acute basilar artery occlusion; Cerebral angiography; Mechanical thrombectomy; Supraselective thrombolysis

Received: November 23, 2015; Revised: January 20, 2016; Accepted: January 26, 2016; Published: April 1, 2016  Show citation