Successful Endovascular Revascularization of Acute Basilar Artery Occlusion Approached via an Aberrant Right Subclavian Artery

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Objective: We report a rare case of endovascular treatment for acute basilar artery occlusion (BAO) approached via the aberrant right subclavian artery (ARSA).

Case Presentation: A 66-year-old woman with atrial fibrillation was admitted for nausea and vomiting. She was progressively losing consciousness. At admission, her National Institutes of Health Stroke Scale (NIHSS) score was 38. Magnetic resonance angiography revealed BAO. An intravenous thrombolysis agent was administered at 2 hours and 20 minutes after symptom onset. Thrombectomy was performed using a stent retriever, resulting in complete recanalization at 4 hours and 39 minutes after symptom onset. While approaching the lesion, an ARSA was found. After the recanalization, her consciousness significantly improved, and her NIHSS score improved from 38 to 6 the day after the operation. She was discharged on day 17 with an NIHSS score of 1.

Conclusion: BAO is considered to have a poor prognosis. However, stent retriever thrombectomy may improve the prognosis of acute BAO. In addition, many anomalies such as ARSA can hinder the endovascular approach to intracranial arteries. Therefore, in-depth knowledge of vascular anatomy is necessary to perform this procedure.