Primary Endovascular Therapy with Clot Retrieval and Balloon Angioplasty for Acute Basilar Artery Occlusion

Abstract

This case report demonstrates that mechanical clot disruption and retrieval may be performed safely and successfully in a child with basilar artery (BA) thrombosis. A 16-year-old boy presented to our institution with locked-in syndrome 20 h after symptom onset. Brain MRI and cerebral angiography findings were consistent with BA occlusion. The child underwent endovascular therapy with clot retrieval followed by balloon angioplasty achieving immediate recanalization and clinical recovery on 3-month follow-up. This case highlights the use of primary neurointerventional devices in children with BA occlusion presenting beyond the conventional therapeutic window for other interventions.

Basilar Artery Occlusion Treated with Mechanical Thrombectomy beyond Eight Hours with Successful Recanalization and Good Functional Outcomes

“…However, there are several reports of patients with BAO who had successful recanalization and good functional outcomes with thrombolysis up to 79 h after symptom onset [1][2][3][4] , and with endovascular mechanical clot retraction up to 36 h after onset [5][6][7] .…”

Thrombolysis in Childhood Stroke

“…Four children underwent balloon angioplasty in addition to IAT (nϭ3) or intra-arterial clot retrieval (nϭ1) without any complication, 10,28,30,31 which indicates that mechanical thrombolysis is also a treatment option in carefully selected children with ischemic stroke. The ongoing growth and the small diameter of the cerebral arteries in childhood suggest that stents are not indicated and appropriately designed catheters are needed.…”

“…The lethal outcome of the boy who presented with a T occlusion and showed no MCA recanalization after IAT is in line with the unfavorable outcome of adults with this type of vessel occlusion. 33 Eight children underwent IAT in 7 cases (additional balloon angioplasty, nϭ3) 10,[27][28][29][30] or intra-arterial clot retrieval followed by balloon angioplasty (nϭ1) 31 for BA occlusion. All children survived, 6 with no or minimal deficits (mRS 0 to 1), one with a mRS of 2, and one remained severely disabled (mRS 4) after a follow-up ranging between 1 and 12 months.…”

Clinically successful late recanalization of basilar artery occlusion in childhood: What are the odds?

“…The site of BA occlusion in the 14 children found in the literature with ABAO and locked-in syndrome was the midthird of the BA in 6 cases [4,[13][14][15]19], the proximal third in 2 cases [21,22] and the distal third in 1 case [5]. In 4 patients there was complete BA occlusion [12,14,18,23] and in 1 the location was not specified [20].…”