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Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report II SESSIONE
“STRATEGIE NEUROVASCOLARI”

Thrombectomy and stenting for acute basilar artery
occlusion with underlying high-grade stenosis

A. GIOPPO*, G. NUZZACO**, P. RIGAMONTI*, F. FREDIANI**, L. VALVASSORI*

* Neuroradiology Unit, Department of Diagnostic and Therapeutic Advanced Technology,
“S. Carlo” Hospital, ASST “Santi Paolo e Carlo”, Milan, Italy
** Neurological and Stroke Unit Department, “S. Carlo” Hospital,
ASST “Santi Paolo e Carlo”, Milan, Italy

INTRODUCTION an occlusion of the mid basilar artery (Figure 1AB).
At 09:06 a.m. the patient was brought to the Angio
Acute Basilar Artery (BA) occlusion is an infrequent suite and intubated.
cause of ischemic stroke that is associated with high Cerebral angiogram confirmed the occlusion of the
(1)
rates of morbidity and mortality . Given that stan- mid BA and showed the presence of a right foetal
dard medical treatment alone is associated with in- posterior cerebral artery.
sufficient recanalization rates and poor outcomes, en- A 6Fr Envoy guiding catheter (Cordis) was placed in
dovascular therapy has recently been regarded as a the left vertebral artery; a 5Fr Sofia catheter (Micro-
promising therapeutic approach for acute basilar ar- vention) was navigated up until the proximal end of
tery occlusion . the thrombus and used for direct aspiration (ADAPT)
(2)
with an aspiration pump; suction was applied for 2
minutes.
CASE REPORT The clot was successfully removed, but a severe un-
derlying focal stenosis was seen in the mid BA.
A 63-year-old man was admitted in the Emergency Repeated angiograms over a period of 10 minutes
Department of our Institution at 6:55 a.m. demonstrated sluggish blood flow post the stenosis
The patient had complained dysarthria, left-side and it was decided to proceed with stent placement to
weakness and hypoesthesia since awakening at 6:00 prevent re-occlusion of the BA. An IV bolus of pla-
a.m. He had a history of hypertension, dyslipidaemia telet glycoprotein IIb/IIIa inhibitor (Aggrastat) was
and smoking. administered, followed by a maintenance infusion.
Neurological examination showed dysarthria, left VII Dilatation of the mid basilar segment was performed
cranial nerve palsy, left hemiparesis and hypoesthesia with a NeuroSpeed PTA balloon 2.5 x 8 mm (Acan-
(NIHSS: 11). dis) and a self-expanding stent CREDO 3.5 x 15 mm
At 07:24 a.m. the patient underwent urgent CT of (Acandis) was delivered by a one-pass technique.
the head that did not reveal any acute abnormality Post-dilatation was achieved with the same 2.5 x 8
(ASPECT score 10 of 10); a subsequent CTA showed mm balloon.

Corrispondenza: Andrea Gioppo, UOC di Neuroradiologia, UOC di Neuroradiologia, Ospedale S. Carlo, via Pio II 3, 20153 Milano
(MI), e-mail: gioppoandrea@gmail.com
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

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