Retrograde thrombectomy in basilar ischemic ictus without posterior vascular access

Abstract

INTRODUCTION:

10% of the strokes affect the posterior circulation, with important neurological deficit and they may compromise the life. Initial management of these patients includes pharmacological thrombolysis and mechanical thrombectomy to re-establish the flow of irrigation from vital structures such as the midbrain and brainstem.

METHOD:

We present the case of an 81-year-old patient, with unsteady gait with left hemianopsia. Basilar and left vertebral artery occlusion were demonstrated by angiotomography, and critical right vertebral artery stenosis. Due a catheterization of the vertebral arteries was not possible, Basilar artery access through a posterior communicating artery was performed.

RESULTS:

Adequate revascularization of the basilar artery was performed, by angiography. However, 12 hours later, the patient presented the re-occlusion of the basilar artery that caused brain death.

CONCLUSION:

Patients with occlusion or severe stenosis in posterior circulation with patency and permeability of the Willis polygon would be candidates for this type of procedure. Further studies are needed to confirm the neurological outcome after stroke in the territory of vital structures with limited vascular access.