Abstract
A 52-year-old man who presented with drowsiness and limb ataxia was admitted to our institution 5 hours after symptom onset. Magnetic resonance diffusion-weighted imaging revealed high signal intensities in the bilateral cerebellum, right hippocampus, and bilateral occipital lobe. Because his neurologic symptoms deteriorated despite medical treatment, emergency neuroendovascular revascularization (ENER) was performed. Diagnostic angiography revealed total occlusion of the right vertebral artery, severe stenosis of the left vertebral (V4) artery, and thrombosis of the basilar tip. Direct intracranial angioplasty without localized intra-arterial thrombolysis was performed for the left V4 stenosis. Immediately after angioplasty and stenting, the thrombus in the basilar tip resolved and the patient’s neurologic symptoms improved remarkably. Therefore, a thrombolytic agent was not required. This case suggests that direct angioplasty for a proximal severe stenotic lesion restored an ante-grade flow for washout of the occluded thrombus, which could be an alternative to ENER for tandem lesions of the vertebrobasilar artery in patients with acute ischemic stroke.
