Basilar artery thrombosis treated with intra-arterial urokinase

Case contributed by RMH Core Conditions

Presentation

Collapse. Decreased GCS. Intubated.

Patient Data

Age: 89 years
Gender: Male

Separate filling defects are demonstrated in the basilar artery and the right vertebral artery distal to the C1 arch. This finding is consistent with thrombus within the right vertebral and basilar artery.

Modality: DSA (angiography)

6 F right CFA sheath inserted. Cerebral DSA showed proximal total occlusion of basilar artery (proximal to AICA).

A 6 F straight envoy guide catheter was placed in the midsegment of the RIGHT Vertebral artery.

Renegade microcatheter placed within and beyond basilar thrombus under roadmap control. IA urokinase was infused distal, within and proximal to the thrombus.

After infusion of 750,000 units of urokinase, TIMI 3 basilar artery recanalization was achieved. Control angiogram showed mild residual elongated stenosis ~40% of the mid basilar artery.

No angiographic complications.

Case Discussion

Basilar artery thrombosis is an important diagnosis not to miss. There is extended time from symptom onset to intervention in posterior circulations strokes than in anterior circulation strokes. 

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Case Information

rID: 34571
Case created: 26th Feb 2015
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

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