Presentation
Rapidly slipped into a coma.
Patient Data
Non-contrast CT head:
Hyperdense distal basilar artery, signifying a thrombus.
No intracranial bleeding or evidence of acute infarction.
The cerebral sulci, ventricles, and basal cisterns are of normal width.
Bilateral widening of the frontoparietal extra-axial compartment is more prominent on the left.
Old lacunar infarct in the right corona radiata, and several tiny infarcts in the right external capsule. Tiny right periventricular infarct.
CTA head and neck:
15-mm-long filling defect in the distal basilar artery, occluding the origin of both PCAs.
Thin right vertebral artery, becoming even thinner distal to the PICA origin.
CT perfusion:
Wide area of reduced, sluggish, and preserved or elevated blood volume covers the bilateral PCA territory as well as the right SCA territory. The right thalamus is more extensively involved than the left one.
Procedure:
Right femoral puncture and placement of a short 8F sheath.
Navigation with catheterization to the left vertebral artery using Neuromax 6 + Bern Select 5F + wire glide 0035'. Image acquisition in several projections. Mechanical thrombectomy employing suction alone: Sofia6 + Phenom2 + Traxcess 014'. Review images. Closure of puncture with Angioseal 8.
Findings:
CT at the start of the procedure showed no bleed.
Diagnostic images showed occlusion at the tip of the basilar artery.
Mechanical thrombectomy using only suction with complete restoration of flow - 3TICI.
CT at the end of the procedure showed no bleed, with mild extravasation of contrast material in the right cerebellum.
No immediate compli
Case Discussion
Lucid and independent individual with well-controlled hypertension.
Upon waking up, the patient told his wife he didn't feel well and could not get up. His consciousness then rapidly deteriorated. Arrived at the ER with a GCS of 4-5.
1.5 hours after waking up, the patient underwent CT-CTA-CTP. The non-contrast CT showed an occluding thrombus in the distal basilar artery but did not show any sign of infarction.
CT perfusion showed reduced flow and preserved or even elevated blood volume throughout the bilateral PCA territory and in the right SCA territory.
He was immediately taken to the catheterization suite, where he underwent a mechanical thrombectomy with full recanalization.
His immediate recovery went surprisingly well.
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