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Thromboaspiration in the Basilar Artery: Report of Two Cases

René Chapota, Emmanuel Houdarta, André Rogopoulosb, Charbel Mounayera, Jean-Pierre Saint-Mauricea and Jean-Jacques Merlanda

a Department of Interventional Neuroradiology, Hôpital Lariboisière, Paris France
b Department of Radiology, Institut Arnault Tzanck, Saint-Laurent du Var, France



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  		FIG 1. Case 1. Anteroposterior (AP) angiograms obtained in a 37-year-old woman with a progressive alteration of consciousness, with a motor ocular deficit, right hemiparesis, and eventual coma.

A, View of the posterior circulation after an injection through the left vertebral artery. The proximal basilar artery is occluded.

B, View of the basilar artery after the injection of 1,000,000 U of urokinase. The basilar artery is mostly recanalized. A residual clot (arrow) occludes the basilar bifurcation.

C, View of the basilar artery after thromboaspiration. The basilar artery is permeable after aspiration with a 4F catheter placed at the level of the thrombus.



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  		FIG 2. Case 2. Angiograms obtained in a 40-year-old woman with a 3-mm sacciform basilar tip aneurysm who was referred for endovascular treatment.

A, AP view of the dominant left vertebral artery, which has a large diameter and is not tortuous.

B, AP view of the posterior circulation obtained after an injection in the left vertebral artery. A small, incidental, top, basilar aneurysm (arrow) is depicted.

C, AP view of the left vertebral artery obtained after placement of the first coil in the aneurysm failed. The vertebral artery is occluded.

D, AP view of the basilar artery obtained after an injection in the right vertebral artery. The thrombus (arrows) extends from the left vertebral into the basilar artery.

E, Nonsubtracted oblique view obtained during catheterization of the basilar artery. The end of the catheter (arrow) is in the V3 segment, and the guidewire (arrowheads) is in the distal V4 segment of the left vertebral artery.

F, AP view of the left vertebral artery and the posterior circulation after thromboaspiration. A small residual clot (arrow) occludes the origin of the left common AICA-PICA.

G, AP view of the left vertebral artery and the posterior circulation obtained after coil placement in the aneurysm and selective fibrinolysis in the left common trunk AICA-PICA. No residual thrombus is present.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X