Successful Recovery After Delayed Thrombectomy for Acute Basilar Artery Occlusion: A Case Report

Leila Afshar  Hezarkhani; Payam  Sariaslani; Fatemeh  Feyzi; Milad  MohamadYari

doi:10.18502/crcp.v9i4.17986

Leila Afshar Hezarkhani Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Payam Sariaslani 1. Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Fatemeh Feyzi Medical Faculty, Kermanshah University of Medical Sciences, Kermanshah, Iran
Milad MohamadYari Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

DOI: https://doi.org/10.18502/crcp.v9i4.17986

Keywords: Basilar artery occlusion; Thrombectomy; Vertebral artery dissection; Stroke recovery; Ischemic stroke

Abstract

Top of the Basilar Syndrome (TOBS) is a rare neurological condition caused by occlusionof the distal basilar artery, often resulting in significant morbidity. TOBS is particularlychallenging to diagnose in younger patients with atypical risk factors. A 34-year-old man presented with vertigo following strenuous exercise. Initial misdiagnosesdelayed treatment, and subsequent imaging revealed left vertebral artery dissectionand basilar artery occlusion. Endovascular thrombectomy performed 41 hours and45 minutes after symptom onset achieved a Thrombolysis in Cerebral Infarction(TICI) score of 2B. Despite complications, including hydrocephalus and pneumonia,multidisciplinary management led to significant recovery, with the patient’s modifiedRankin Scale (mRS) score improving from 4 at discharge to 1 at one year. This caseunderscores the importance of clinical vigilance, advanced imaging, and endovascularthrombectomy in managing TOBS. Even with delayed intervention, multidisciplinarycare can facilitate favorable outcomes in young patients with rare presentations.