A Case of Acute Atherosclerotic Basilar Artery Occlusion Treated by Angioplasty with a Stent Retriever and Combined Antithrombotic Therapy.

Objective: The optimal treatment strategy for large-vessel occlusion (LVO) related to intracranial atherosclerotic disease (ICAD), particularly for tandem lesions that complicate access and device delivery, remains unclear. We report a case in which angioplasty with a stent retriever (SR) and combined antithrombotic therapy was effective in treating re-occlusion associated with dissection of the residual stenosis after thrombectomy for acute atherosclerotic occlusion of the basilar artery (BA) with the left vertebral artery (VA) stenosis.

Case Presentation: An 80-year-old woman was brought to our hospital with progressively worsening consciousness and tetra-paresis. MRA revealed occlusion of the middle to proximal portion of the BA. The patient underwent percutaneous transluminal angioplasty using a balloon catheter for severe stenosis at the origin of the left VA, followed by mechanical thrombectomy for the BA occlusion. While initial recanalization was achieved, residual stenosis in the proximal portion of the BA led to re-occlusion. An attempt at angioplasty with a balloon catheter failed to reach the stenotic segment due to stenosis and tortuosity of the left VA. Consequently, the SR was redeployed into the BA, and a loading dose of antiplatelet agents and intravenous anticoagulant were administered during prolonged deployment. Following the confirmation of BA patency, the SR was re-sheathed and removed. The patient achieved remarkable improvement in consciousness and tetra-paresis without postoperative re-occlusion of the BA.

Conclusion: Angioplasty with a SR and combined antithrombotic therapy may be a useful treatment option for ICAD-related LVO, particularly in cases such as tandem lesions that hinder access and make distal balloon catheter navigation challenging.