BASILAR ARTERY REOCCLUSION WITHIN 24 HOURS AFTER MECHANICAL THROMBECTOMY SUCCESSFULLY TREATED WITH NEW INTERVENTION.

Abstract

Acute basilar artery occlusion (BAO) may cause ischemia in the region of brainstem, parts of the thalamus, occipital lobes, and cerebellum, resulting in severe disability or mortality rate above 70%. Recurrent BAO has been described in only a small number of cases. We present a case of repeated mechanical thrombectomy (MT) for the tip of basilar artery (BA) reocclusion within 24 hours. A previously healthy 37-year-old male presented with occipital headache, nausea, vomiting, right-sided hemiparesis, within 30 minutes from the onset and NIHSS 18. The patient was vaccinated against COVID-19 with Pfizer-BioNTech vaccine seven days before the onset. On initial computed tomography (CT) scan, the pc-ASPECTS was 10 and CT angiography (CTA) showed the tip of BA thrombosis. Intravenous thrombolytic therapy was administered, followed by MT, achieving mTICI 3 and NIHSS 5 after the procedure. Within 24 hours from the first MT, there was neurological deterioration followed by coma. Urgent CT/CTA was performed and rethrombosis of BA was confirmed with pc-ASPECTS 10. MT was repeated with mTICI 2b. Stroke etiology was undetermined. After 17 days, the patient was discharged and referred to continue rehabilitation treatment. After 90 days of stroke, his NIHSS was 2 and mRS 1. We can consider that early recurrent BAO can be successfully treated with repeated MT.