Stent-based mechanical thrombectomy in acute basilar artery occlusion

Abstract

Stent-based mechanical thrombectomy was recently proposed as an effective alternative to other mechanical techniques to achieve recanalization of large-vessel embolic occlusions in the anterior circulation. To our knowledge, there are no reports of the use of this technique in acute basilar artery occlusion (ABAO). We present a patient with complete endovascular recanalization of ABAO using a stent-based thrombectomy technique. Advantages and limitations of this technique in the management of ABAO are discussed. The stent-thrombectomy technique is promising, and will need further evaluation in posterior circulation stroke.

Introduction

Stent-based mechanical thrombectomy was recently proposed as a very effective alternative to other mechanical techniques to achieve recanalization of large-vessel embolic occlusions of the anterior circulation.[1], [2], [3], [4] Surprisingly high recanalization rates were achieved with this technique across the full range of carotid occlusion patterns.² However, there are no reports of the use of this technique in acute basilar artery occlusion (ABAO).

In the anterior circulation, stent-based thrombectomy requires proximal occlusion of the internal carotid artery (ICA) with a large lumen balloon-tipped guiding catheter, followed by gentle but thorough suction during the thrombectomy step. This may be a limitation of the technique in the posterior circulation due to the smaller diameter of the vertebral arteries and bilateral supply to the basilar artery (BA). We present a complete angiographic recanalization of an ABAO using stent-based thrombectomy.