case_images: PMC10830138_01
case_images: Intracranial angiography before mechanical thrombectomy. a, b PTA and basilar artery thromboembolic site in positive and lateral angiography of the right ICA, respectively. c, d Lateral angiography of the right and left vertebral arteries, respectively.
case_images: crn-2024-0016-0001-535871_F01.jpg
case_images: PMC10830138_01_crn-2024-0016-0001-535871_F01.jpg
case_images: F1
case_images: Angiography revealed visible PTA with tortuous vessel course at the C4 segment of the right ICA (Fig. 1a, b), occlusion of the distal basilar artery at the PTA anastomotic site (Fig. 1a, b), and hypoplasia of the right vertebral artery with no visualization beyond V3 and no visualization of the left vertebral artery beyond V4 (Fig. 1c, d).
case_images: Intraoperative and postoperative images. a Avigo microguidewire successfully traversing the thrombotic occlusion segment. b, c Postoperative right ICA angiography in positive and lateral views, respectively. d Intraoperative contrast extravasation. e Head CT examination 24 h after operative, showing brain stem infarction. f Diameters of the primitive trigeminal and basilar arteries.
case_images: crn-2024-0016-0001-535871_F02.jpg
case_images: PMC10830138_01_crn-2024-0016-0001-535871_F02.jpg
case_images: F2
case_images: Consequently, we switched to a stiffer and more supportive microguidewire, Avigo, which allowed us to traverse the thrombotic occlusion segment successfully (Fig. 2a); however, we still could not advance the distal access catheter. However, the thrombus was not retrieved, and the subsequent angiography revealed that the basal artery remained occluded with a small amount of contrast extravasation (Fig. 2d), suggesting a small amount of bleeding. Follow-up angiography showed persistent occlusion at the embolism site (Fig. 2b, c). A follow-up CT performed 24 h postoperatively revealed a new brainstem wedge-shaped hypodensity, indicating cerebral infarction (Fig. 2e) and patchy hyperdensity in the posterior part of the cerebral falx, suggesting hemorrhage.