A case of successful interventional treatment in acute basilar artery occlusion

We describe a case of successful recanalization and favorite clinical outcome of a patient with acute basilar artery occlusion (BAO) and interventional treatment (IT). A 67-year-old patient presented in a comatose state, with quadriplegia, and decerebrate posturing. His initial Glasgow-Liege Coma Scale (GLCS) score was 11, Institutes of Health Stroke scale (NIHSS) 24, and modified Rankin scale (mRS) 5. Non-contrast CT was performed before IT. Due to suspicion of BAO, an immediate cerebral angiography was performed. It demonstrated BAO in the middle and distal segment. Intra-arterial catheter based treatment was performed including balloon angioplasty and thrombolysis with 20 mg Actilyse (within 4 h of symptoms onset). An optimal angiographic result was achieved. After the procedure the patient was treated in ICU with another 10 mg Actilyse infused over the next 3 h. Because of improvement in neurological condition, the patient was extubated 12 h later. On the first day, he regained consciousness, being able to speak, without new neurologic deficit. Control CT did not demonstrate new signs of ischemic stroke. CT angiography showed complete basilar artery recanalization in the distal part and a moderate residual stenosis in the middle segment. On the 7th day the patient was discharged with NIHSS 7, GLCS 20, and mRS 3. We believe that the success in our case was a result of the prompt clinical diagnosis, fast access to the cathlab and early mechanical–pharmacological recanalization.