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Delayed basilar artery recanalization 100 hours after symptom onset
  1. Imran Chaudry1,
  2. Wuwei Feng2,
  3. Christine Holmstedt2,
  4. Raymond Turner2,
  5. Robert Adams2,
  6. Aquilla S Turk1
  1. 1Stroke and Cerebrovascular Center, Department of Radiology, Medical University of South Carolina, South Carolina, USA
  2. 2Stroke and Cerebrovascular Center, Department of Neurosciences, Medical University of South Carolina, South Carolina, USA
  1. Correspondence to Imran Chaudry, Assistant Professor, Stroke and Cerebrovascular Center, Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Charleston, SC 29425, USA; chaudry{at}musc.edu

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Introduction

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.

Case report

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.

Figure 1

(A and B) Initial MRA demonstrating occlusion of the bilateral vertebral arteries and proximal basilar artery and patency of the basilar apex, bilateral superior cerebellar arteries, bilateral posterior cerebral arteries supplied by bilateral posterior communicating arteries.

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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