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Endovascular treatment of basilar artery occlusion by manual aspiration thrombectomy
  1. Brian T Jankowitz1,
  2. Aitziber Aleu2,
  3. Ridwan Lin2,
  4. Mouhammad Jumaa2,
  5. Hilal Kanaan1,
  6. Dean Kostov1,
  7. Maxim Hammer2,
  8. Ken Uchino2,
  9. Larry R Wechsler2,
  10. Michael Horowitz1,
  11. Tudor G Jovin2
  1. 1Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  2. 2Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Tudor G Jovin, Stroke Institute, 200 Lothrop Street, Suite C-400, Pittsburgh, PA 15218, USA; jovintg{at}


Background and purpose Basilar artery occlusion remains one of the most devastating subtypes of stroke. Intravenous and intra-arterial therapy have altered the natural history of this disease; however, clinical results remain poor. Therefore, exploring more aggressive and innovative management is warranted.

Methods Six consecutive patients presenting with a basilar artery occlusion were treated with the same general algorithm of intra-arterial tissue plasminogen activator and mechanical thrombectomy with the Merci retrieval system. If complete recanalization was not achieved after two passes, manual syringe aspiration through a 4.3F catheter was employed.

Results All interventions utilizing aspiration thrombectomy resulted in recanalization, with five out of six cases displaying TIMI3/TICI3 flow and one patient resulting in complete recanalization of the basilar artery with persistent thrombus in one P2 segment (TIMI2/TICI2B). All patients survived, with five out of six independent in activities of daily living at 3 months (mRS 0–2).

Conclusions Our small case series indicates that aspiration thrombectomy performed manually through a 4.3F catheter can facilitate recanalization of basilar artery occlusion with acceptable clinical outcomes.

  • Intra-arterial
  • basilar occlusion
  • aspiration
  • thrombectomy
  • atherosclerosis
  • stroke
  • angiography
  • thrombectomy
  • thrombolysis

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  • Competing interests Jovin has received consulting and speaker fees from Co-Axia, ev3, and Concentric Medical.

  • Ethics approval This study was conducted with the approval of the IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.