2023 Volume 51 Issue 2 Pages 150-154
A 65-year-old male presented with impaired consciousness and was evaluated at 1.5 h after onset. The National Institutes of Health Stroke Scale (NIHSS) score was found to be 36 while the posterior circulation Alberta Stroke Program Early CT score (ASPECTS) was observed to be 8. Further, magnetic resonance angiography (MRA) showed basilar artery occlusion. Therefore, tissue plasminogen activator was administered, and thrombectomy was performed. The basilar artery was recanalized although right vertebral artery stenosis persisted. Medical treatment was initiated, and rehabilitation was performed. Unfortunately, the patient's state of consciousness deteriorated and right hemiparesis was observed on Day 5 post-thrombectomy. As angiography displayed reocclusion of the right vertebral artery, emergent angioplasty was performed. The patient recovered his consciousness, and a stent was inserted in the right vertebral artery one day after surgery. The treatment strategy for a tandem lesion in the posterior circulation is unclear regarding whether anterograde or retrograde approach is better. In some cases of posterior circulation, collateral flow is poor. The retrograde approach and vertebral artery stenting are an effective option for basilar occlusion due to a tandem lesion.
