Basilar artery occlusion in a child: "clot angioplasty" followed by thrombolysis

Basilar artery occlusions are rare but have a very poor prognosis. Intra-ar terial thrombolysis may produce recanalization and better clinical outcome. A short delay between the onset of symptoms and thrombolysis is considered essential for successful recanalization and for the smallest possible risk of haemorrhagic complications. We present a case of basilar artery occlusi on in an S-year-old child, which was treated by "clot angioplasty" followed by intra-arterial thrombolysis. Thirty hours after progressive alteration of consciousness, speech disturbances and left arm paresis, the child becam e comatose with decerebrate rigidity. A CT scan showed parenchymal ischaemi c lesions. Angiography (performed 36 h after the onset of symptoms) showed a total occlusion of the basilar artery. A clot angioplasty was performed b y placing a balloon catheter within the thrombus and inflating it several t imes in the occluded segment of the basilar artery. Thrombolysis was then p erformed through the balloon catheter. The basilar artery was only partiall y recanalized at the end of the procedure, but the perforating arteries of the brain stem had reappeared on angiography. Three months later the child had completely recovered to a normal clinical status. In conclusion, the ve ry poor natural prognosis of basilar artery occlusion requires aggressive m anagement. Recanalization of the basilar artery may be performed even late after the onset of symptoms. Clot angioplasty allows partial recanalization , which may increase the efficiency of thrombolysis.