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Basilar artery occlusion (BAO) is a devastating event, often resulting in significant morbidity and mortality. A few case series have suggested that local intra-arterial thrombolysis can improve recanalization and clinical outcomes.1–3 We report a case of BAO treated with endovascular thrombectomy, balloon maceration and stenting at approximately 100 h after initial symptom onset.
A 51-year-old white man with a history of tobacco abuse presented to a community emergency department (ED) with a 1-day history of left hemiparesis, diplopia, headache and slurred speech. In the ED, he was noted to have a right facial droop, left hemiparesis, dysarthria and ataxia correlating with a National Institute Health Stroke Scale (NIHSS) of 9. Magnetic resonance time of flight angiography (MRA) suggested a BAO extending from the vertebrobasilar junction (VBJ) to the distal basilar artery. The basilar apex was patent, supplied by large bilateral posterior communicating arteries, which opacified the bilateral superior cerebellar arteries, basilar apex and bilateral posterior cerebral arteries (figure 1A,B). A vertebrobasilar flow-limiting stenosis with competing flow from the bilateral posterior communicating arteries could not be excluded based on time of flight imaging.
The patient was not offered intravenous or intra-arterial thrombolytic therapy as he was beyond standard treatment windows of 4.5 and 6 h. …
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