Basilar artery occlusion recanalized with thrombectomy, PTA and stenting via right transradial access

• An 85-year-old female patient presented with a basilar syndrome (NIHSS 15) with unknown onset. CT/CTA revealed small subacute infarcts in both cerebellar hemispheres and an occlusion of the proximal basilar artery. 
• Bilateral ACP P1 hypoplasia
• rTPA was not given. The patient underwent immediate mechanical recanalization.

Treatment Chosen

• Tortuous aortic anatomy
• Right radial access (7F Terumo Slender Sheath)
• RIST 0.079 and 5F Berenstein Select provide an easy & stable access to the right vertebral artery (VA, V2/3)

Aortic arch

Right radial access

Right VA - RIST 0.079

• RIST 0.079, 5F Sofia (115 cm)
• Occlusion at the vertebrobasilar junction
• Single pass thrombectomy manoeuvre with a Solitaire 4 x 40 mm SR
• High-grade stenosis at the vertebrobasilar junction (arrow)

Pre-thrombectomy

Post-thrombectomy

• Overlapping PTA with a Maverick 2 mm PTA-balloon
• Exchange manoeuvre via 300 cm Synchro 0.014 wire & SL10 microcatheter
• Stenting with a Neuroform Atlas (3 x 12 mm) self-expandable stent (arrows)

PTA

Post-stenting

Results

• RIST 0.079 provides an easy-to-use and stable base for even complex stroke interventions requiring PTA and intracranial stenting.
• The patient was discharged to rehabilitation with improved hemiparesis and normalized vigilance.

Supported by Medtronic