Successful thrombectomy of top-of-the-basilar artery occlusion - difficult to detect in clinical practice: A case report

Top-of-the-basilar artery occlusion frequently causes infarction of the midbrain, thalamus, and portions of the temporal and occipital lobes as the vascular supply of these regions comes from the posterior communicating and posterior cerebral arterial tributaries of the basilar artery. Clinical signs include an array of visual, oculomotor, and behavioral abnormalities, usually without prominent motor dysfunction, which makes diagnosis challenging for those inexperienced with these sign. We describe a 59-year-old male presenting with acute ischemic stroke due to top-of-the-basilar artery occlusion. Despite attempting several paraclinical examinations relating the sudden coma with Glasgow Coma Scale of 6 points, the neuroimaging detected the large vessel occlusion that was difficult to recognize. After confirming top-of-the-basilar artery occlusion, the recanalization was realized immediately. The patient was discharged with good clinical recovery

A rare case of fusiform basilar trunk aneurysm

Aneurysms in the posterior circulation and distal sites are more common among the pediatric population than among adults, with a male predominance. Symptoms of an aneurysm in the posterior circulation can include a stiff neck or severe headache due to a ruptured aneurysm, whereas an unruptured aneurysm can cause mass effects or neurological deficits. However, in children, the complete occlusion of the aneurysm while preserving the flow of the main artery can be difficult to achieve when attempting a stent-assisted coil embolization technique. A 25-month-old girl presented with left hemiparesis and was diagnosed with a basilar artery aneurysm 10 months prior, but she did not receive any specific treatment. No history of trauma and no significant familial history were recorded. Angiography showed a fusiform aneurysm on the basilar artery trunk, which was successfully occluded using stent-assisted coiling following dual antiplatelet therapy with clopidogrel and aspirin. She was discharged with the complete restoration of motor deficits

Rescue intracranial stenting in acute ischemic stroke (study).

BACKGROUND AND PURPOSE: In cases of acute ischemic stroke that are caused by intracranial large vessel occlusion, rescue intracranial stenting has recently become a treatment option to achieve recanalization in patients when mechanical thrombectomy fails. However, there have been few studies to date that support this beneficial treatment. Our goal is to analyze whether the use of rescue intracranial stenting would improve non-poor prognosis in patients 3 months posttreatment. METHODS: This was a retrospective analysis of a prospective cohort of patients with acute ischemic stroke who were treated with rescue stenting at our hospital. Inclusion criteria for the study consisted of evidence of intracranial large vessel occlusion, absence of intracranial hemorrhage, and severe stenosis or reocclusion after mechanical thrombectomy. Tandem occlusions, failure to follow up after discharge, and a severe combined illness concomitant with acute ischemic stroke were excluded. The primary outcome was the non-poor outcome rate at 3 months and postprocedural symptomatic intracerebral hemorrhage. RESULTS: The posttreatment outcomes of 85 eligible patients who received rescue intracranial stenting between August 2019 and May 2021 are reported. In total, 82 of these patients (96.5%) had successful recanalization and 4 (4.7%) experienced symptomatic intracerebral hemorrhage. In total, 47 (55.3%) patients had non-poor and 35 (41.2%) good outcomes at 3 months after treatment with rescue intracranial stenting. The use of dual antiplatelet therapy was associated with new infarcts (relative risk = 0.1; 95% confidence interval 0.01-0.7) and symptomatic intracerebral hemorrhage (relative risk = 0.1; 95% confidence interval 0.01-0.9). CONCLUSION: Our study suggests that despite the occurrence of postprocedural symptomatic intracerebral hemorrhage in a low proportion of cases, rescue intracranial stenting could be an important alternative treatment after mechanical thrombectomy failure