The initial diagnosis is often delayed as not identified on the non contrast CT. The so called "stuttering" onset is seen in at least 30% of patients with basilar artery occlusion, but can lead to diagnoses other than vertebrobasilar ischemia being considered. With appropriate suspicion, hyperdense basilar artery sign can be identified, prompting the diagnosis and confirmation with immediate CTA.
Basilar artery occlusion is associated with up to 85% mortality untreated, is often diagnosed outside accepted time windows for IV tPA, but success with intra-arterial therapy can be achieved out to 24 hours post onset. Increasingly the stent retrievers are being used over IA lytic therapy, and offer more rapid and more complete recanalisation and reperfusion. This works particularly well for embolic occlusions seem for example in AF - if atherothrombosis with high grade underlying intracranial atherosclerosis and stenosis is found angioplasty or stent assisted angioplasty can be performed.