Introduction Basilar artery (BA) occlusion resulting from a critically narrowed atherosclerotic stenosis can be effectively treated with stent implantation preceded by balloon predilation. This approach increases the chances of successful long-term outcomes and patient independence. Intraoperative management of unexpected bleeding complications is possible, and good long-term results are still achievable. Pharmacological treatment during and after rescue stenting is a debated topic, particularly in regards to bleeding complications during the procedure.

Aim of Study We present a case of BA acute ischemic stroke successfully treated with mechanical thrombectomy and rescue stenting, where an unexpected bleeding complication occurred, managed effectively with a balloon microcatheter.

Methods The mechanical thrombectomy involved the use of an aspiration catheter and a stent retriever. Balloon angioplasty was performed to dilate the critical stenosis, followed by placement of a stent. The bleeding complication was managed with a balloon microcatheter. A bolus of Eptifibatide was administered during stent implantation, followed by a continuous infusion for 24 hours and then dual antiplatelet therapy.

Results Normal blood flow through the vertebrobasilar system was fully restored, with follow-up imaging revealing minimal contrast agent leakage into the subarachnoid space and no hematoma formation. The patient showed excellent clinical outcomes, with mRS0 and a NIHSS0. A month later, follow-up imaging revealed no new ischemic lesions, the stent and the entire vertebrobasilar system remained patent.

Conclusion Rescue stenting is an effective and efficient method for treating basilar artery occlusion resulting from significant stenosis, and bleeding complications can be managed intraoperatively without changing pharmacological antiplatelet therapy.

Disclosure of Interest Nothing to disclose.