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AJNR - American Journal of Neuroradiology

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Treatment of Vertebrobasilar Occlusion by Using a Coronary Waterjet Thrombectomy Device: A Pilot Study

Thomas E. Mayer^a, Gerhard F. Hamann^b,c, Gernot Schulte-Altedorneburg^a and Hartmut Brückmann^a

^a Department of Neuroradiology, Klinikum Grosshadern, University of Munich, Germany
^b Department of Neurology, Klinikum Grosshadern, University of Munich, Germany
^c Department of Neurology, Dr. Horst Schmidt Klinik, Wiesbaden, Germany

View larger version (115K): [in a new window]   FIG 1. Patient 7, a 43-year-old male, with hemiplegia right, anarthria, and dysphagia for 7.5 hours. Occlusion of the extra- and intracranial left VA and the entire BA is shown.

View larger version (89K): [in a new window]   FIG 2. Collateralization of the tip of the BA.

View larger version (112K): [in a new window]   FIG 3. The Choice-PT microwire (black) with its tip in the posterior cerebral artery (white vessels) straightened the atlas loop (white line in the roadmap) and the Angiojet reached the basilar tip.

View larger version (81K): [in a new window]   FIG 4. Complete thrombus extraction was achieved, but a high-grade stenosis of the VA remained.

View larger version (104K): [in a new window]   FIG 5. The stenosis worsened due to rethrombosis despite heparinization (ACT >250).

View larger version (93K): [in a new window]   FIG 6. Therefore, tirofiban was infused, and a 4-mm Medtronic stent was implanted. Complete recanalization was achieved. Shortly after the procedure, the patient improved significantly and returned to work.