Direct Aspiration for Basilar Artery Recanalization

A 69-year-old patient was admitted to the emergency department of his local hospital with acute neurologic symptoms, including left-sided weakness, dysarthria, and decreased level of consciousness. The time of clinical onset was unknown. The patient had a history of atrial fibrillation and was treated with rivaroxaban. Imaging studies, including noncontrast cranial computed tomography and computed tomography angiography, confirmed a distal basilar artery occlusion with corresponding brainstem infarcts and a pc-ASPECTs of 6. The National Institutes of Health Stroke Scale (NIHSS) score was 13, and the modified Rankin scale (mRS) score was 5. The decision was made to perform endovascular recanalization, and the patient was transferred to our hospital. The procedure was successfully performed using contact aspiration as a first-line approach, resulting in complete recanalization of the basilar artery and persistent occlusion of the right superior cerebellar artery. Postinterventional imaging revealed infarct extension into adjacent brain regions, particularly the bilateral pons, midbrain, and cerebellar vermis. During the subsequent clinical course, including nosocomial pneumonia, the patient was stabilized with appropriate antibiotic therapy and discharged in an improved general condition to begin rehabilitation. This chapter’s main topic is the endovascular recanalization of the basilar artery (BA) using contact aspiration. We discuss how this interventional technique was used to eliminate the arterial occlusion and potentially prevent serious neurological consequences.