A Case of Basilar Artery Occlusion due to Vertebral Artery Stenosis Treated with a Combination of Intraarterial Fibrinolytic Therapy and Percutaneous Transluminal Angioplasty

摘要

We encountered a case of stroke caused by a basilar artery embolism due to stenosis at the origin of the right vertebral artery. The patient was successfully treated with a combination of intraarterial fibrinolytic therapy and percutaneous transluminal angioplasty (PTA). A 57-year-old man complained of transient ischemic symptoms such as vertigo, tinnitus and vomiting. CT scan and MRI revealed multiple infarctions in the cerebellar hemispheres. Subclavian angiography demonstrated focal stenosis at the origin of the right vertebral artery and complete occlusion of the left vertebral artery. The next day, the patient suddenly became comatose. Emergent angiography performed within an hour confirmed occlusion of the basilar artery. Recanalization of the basilar artery was obtained with intraarterial fibrinolytic therapy using 6.4 million units of tissue plasminogen activator. Subsequently, PTA was performed for the focal stenosis of the right vertebral artery. Dilatation with a 3.0 mm balloon angioplasty catheter resulted in improvement of the luminal diameter in the stenotic region. The patient demonstrated a dramatic recovery from the coma during the procedure and was discharged without neurological deficits. This method is useful for acute-stages of vertebro-basilar occlusive disease.