Basilar Artery Thrombosis

Question: for doctors only.how to treat a case of basilar artery thrombosis with multiple infarcts.pt is male 77 ,DM,HT? pt.is unconcious since 13 days,plantar extensor,urine output declining

Answer: Patients with symptomatic stenosis of the basilar artery are usually initially treated medically with antiplatelet agents and/or systemic anticoagulation. Despite this, the risk of stroke remains high. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study reported the annual risk of stroke in the basilar artery territory as 20% for patients with symptomatic basilar artery stenosis treated with aspirin and 12% for those treated with warfarin. For the subset of patients for whom medical therapy fails, the therapeutic options are limited. Surgical bypass-grafting for basilar artery stenosis is technically demanding and the results are often disappointing. Successful balloon angioplasty of the basilar artery was first reported by Sundt et al in 1980; however, intraprocedural vessel rupture, elastic recoil, and flow-limiting intimal dissection remain potential problems that have restricted its use. The advent of new-generation, flexible stents has enabled reliable and atraumatic percutaneous access of the intracranial vasculature. We report two cases in which elective primary stenting without preceding balloon angioplasty of symptomatic, high-grade, basilar artery stenosis was performed without complications and with excellent angiographic results (no residual stenosis). The possible indications for primary stenting of basilar artery occlusive disease and the technical aspects of this procedure are discussed.