case_images: PMC11827499_01
case_images: First IS occured. (A) DWI revealed an acute infarct lesion in the right temporal lobe. (B) MRA showed a decrease in the distal branches of the right posterior cerebral artery and no development of the left vertebral artery.
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case_images: An 80-year-old right-handed male who was admitted for acute IS presented with consciousness and vomiting for 2 hours; he had experienced IS in the vertebrobasilar territory forty-eight days prior (Figure 1a), accompanied by a decrease in the distal branches of the right posterior cerebral artery (Figure 1b).
case_images: Second admission due to RIS. (A and B) RIS onset before using TNK, presented with DWI, confirmed infarction in the right thalamus, bilateral cerebellar hemispheres, and vermis.(C) MRA showed occlusion on a left vertebral artery and the distal basilar artery. (D) 97 minutes later after IVT with TNK, DSA showed recanalization in the bilateral superior cerebellar artery, left posterior cerebral artery and left vertebral artery. (E) After thrombectomy,DSA showed recanalization in the right posterior cerebral artery.
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case_images: A CT scan ruled out cerebral hemorrhage, while MRA and DWI revealed occlusion of the left vertebral artery and the distal basilar artery (Figure 2c), along with infarction in the right thalamus, bilateral cerebellar hemispheres, and vermis (Figure 2a and b). Ninety-seven minutes after IVT with TNK, we performed digital subtraction angiography (DSA)-guided recanalization of the distal basilar artery and the left vertebral artery, and only the right posterior cerebral artery was occluded (Figure 2d). Subsequently, a thrombectomy was performed on the right posterior cerebral artery, and reperfusion in the posterior circulation was achieved successfully (Figure 2e).