Mechanical thrombectomy for basilar artery occlusion: a case report of successful revascularization

Background. Basilar artery occlusion (BAO) is a rare but life-threatening form of acute ischemic stroke (AIS) associated with high morbidity and mortality. While mechanical thrombectomy (MT) is established as the standard of care for large vessel occlusion (LVO) in the anterior circulation, its role in posterior circulation strokes is less clearly defined. This case report illustrates the effectiveness of direct MT in BAO management when intravenous thrombolysis is contraindicated.

Case presentation: A 38-year-old female presented with sudden-onset coma and quadriplegia. Neuroimaging revealed complete occlusion of the middle third of the basilar artery with absent contrast filling in its cranial segment. Due to contraindications to intravenous thrombolysis, the patient underwent urgent endovascular treatment. Direct MT was performed using an aspiration catheter and a stent retriever, resulting in full recanalization (TICI 3). The patient showed early neurological recovery, including restoration of spontaneous breathing and consciousness. She was discharged with only mild residual deficits, specifically a neocerebellar syndrome.

Conclusion. This case supports the growing evidence that direct mechanical thrombectomy is a safe and eff ective therapeutic option for posterior circulation strokes such as BAO, especially when systemic thrombolysis is contraindicated. Timely diagnosis, advanced neuroimaging, and rapid endovascular intervention remain crucial for achieving favorable outcomes in this high-risk population.

1. Feigin V.L., Abate M.D., Abate Y.H., Abd ElHafeez S., AbdAllah F., Abdelalim A. et al. Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. Neurology. 2024;23:973–1003. doi: 10.1016/S1474-4422(24)00369-7

2. Raha O., Hall C., Malik A., D'Anna L., Lobotesis K., Kwan J., Banerjee S. Advances in mechanical thrombectomy for acute ischaemic stroke. BMJ medicine. 2023;2:e000407. doi: 10.1136/bmjmed-2022-000407

3. Malik A., Drumm B., D'Anna L., Brooks I., Low B., Raha O et al. Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials. BMC neurology. 2022;22:415. doi: 10.1186/s12883-022-02953-2

4. Bracard S., Ducrocq X., Mas J.L., Soudant M., Oppenheim C., Moulin T., Guillemin F. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. The Lancet. Neurology. 2016;15:1138–1147. doi: 10.1016/s1474-4422(16)30177-6

5. Menon B.K., Demchuk A.M. Computed Tomography Angiography in the Assessment of Patients With Stroke/TIA. The Neurohospitalist. 2011;1:187–199. doi: 10.1177/1941874411418523

6. Tao C., Qureshi A.I., Yin Y., Li J., Li R., Xu P. et al. Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry. Circulation. 2022;146:6–17. doi: 10.1161/circulationaha.121.058544

7. Lee E.J., Jeong H.Y., Kim J., Park N.H., Kang M.K., Lee D. et al. Procedure Time of Endovascular Thrombectomy as Performance Measure of Acute Stroke Treatment. Neurointervention. 2025;20:71–81. doi: 10.5469/neuroint.2025.00178

8. Karpenko A., Keegan J. Diagnosis of Coma. Emergency medicine clinics of North America. 2021;39:155–172. doi: 10.1016/j.emc.2020.09.009

9. Molad J. CT Perfusion: More Than What You Thought. AJNR. American journal of neuroradiology. 2021;42:73–74. doi: 10.3174/ajnr.A6969

10. Vergouwen M.D., Algra A., Pfeff erkorn T., Weimar C., Rueckert C.M., Thijs V. et al. Time is brain(stem) in basilar artery occlusion. Stroke. 2012;43:3003–3006. doi: 10.1161/strokeaha.112.666867

11. Chiasakul T., De Jesus E., Tong J., Chen Y., Crowther M., Garcia D. et al. Inherited Thrombophilia and the Risk of Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. Journal of the American Heart Association. 2019;8:e012877. doi: 10.1161/jaha.119.012877

12. Liu K., Song B., Palacios I.F., Inglessis-Azuaje I., Deng W., McMullin D. et al. Patent Foramen Ovale Attributable Cryptogenic Embolism With Thrombophilia Has Higher Risk for Recurrence and Responds to Closure. JACC. Cardiovascular interventions. 2020;13:2745–2752. doi: 10.1016/j.jcin.2020.09.059

13. Berkhemer O.A., Fransen P.S., Beumer D., van den Berg L.A., Lingsma H.F., Yoo A.J. et al. A randomized trial of intraarterial treatment for acute ischemic stroke. The New England journal of medicine. 2015;372:11–20. doi: 10.1056/NEJMoa1411587

14. Goyal M., Menon B.K., van Zwam W.H., Dippel D.W., Mitchell P.J., Demchuk A.M. et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (London, England). 2016;387:1723–1731. doi: 10.1016/s0140-6736(16)00163-x

15. Liu X., Dai Q., Ye R., Zi W., Liu Y., Wang H. et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. The Lancet. Neurology. 2020;19:115–122. doi: 10.1016/s1474-4422(19)30395-3

16. Wang R., Li S., Hao L., Wang Z., Ge Z., Yang S. A meta-analysis of intravenous thrombolysis versus bridging therapy for ischemic stroke. Medicine. 2022;101:e30879. doi: 10.1097/md.0000000000030879

17. Langezaal L.C.M., van der Hoeven E., Mont'Alverne F.J.A., de Carvalho J.J.F., Lima F.O., Dippel D.W.J. et al. Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion. The New England journal of medicine. 2021;384:1910–1920. doi: 10.1056/NEJMoa2030297

18. Siow I.,Tan B.Y.Q., Lee K.S., Ong N., Toh E., Gopinathan A. et al. Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion. Journal of stroke. 2022;24:128–137. doi: 10.5853/jos.2021.02082

19. Caso V., Turc G., Abdul-Rahim A.H., Castro P., Hussain S., Lal A. et al. European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke. European stroke journal. 2024;9:800–834. doi: 10.1177/23969873241247978