Matsushima Yujiro, Sanada Takahiro, Tucker Adam, Kinoshita Manabu, Kimura Teruo
Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan.
Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
J Neurosurg Case Lessons. 2025 Jun 9;9(23). doi: 10.3171/CASE25171.
Mechanical thrombectomy (MT) for acute basilar artery occlusion (BAO) has become the standard of treatment. Indications for MT in cases of BAO are determined by the degree of activities of daily living before onset, clinical severity, extent of baseline ischemia, and time from onset.
A 43-year-old woman was treated by endovascular intervention for BAO with delayed occlusion of the artery of Percheron (AOP) due to presumed distal thrombus migration. After a fluctuating mild clinical course of more than 60 hours, the patient was finally transferred to the author's institution, presenting with severely impaired consciousness (Glasgow Coma Scale score of 7). The radiological assessment suggested initial BAO followed by distal thrombus migration, resulting in an acute AOP occlusion. Emergency MT was performed because the onset of severe symptoms had worsened within the last 16 hours. Endovascular intervention resulted in complete vascular reperfusion with an abrupt return of consciousness and a modified Rankin Scale score of 2 four months after transfer.
Understanding the anatomical and hemodynamic relationships between the BA and AOP is important for the effective treatment of acute BAO. In particular, ischemic changes in the posterior circulation can be reversible despite prolonged symptom duration. https://thejns.org/doi/10.3171/CASE25171.
急性基底动脉闭塞（BAO）的机械取栓术（MT）已成为治疗标准。BAO病例中MT的适应症由发病前日常生活活动程度、临床严重程度、基线缺血范围以及发病时间决定。
一名43岁女性因推测远端血栓迁移导致大脑后动脉丘脑穿通动脉（AOP）延迟闭塞而接受了BAO的血管内介入治疗。在经历了60多个小时波动的轻度临床过程后，患者最终被转至作者所在机构，此时意识严重受损（格拉斯哥昏迷量表评分为7分）。影像学评估提示最初为BAO，随后远端血栓迁移，导致急性AOP闭塞。由于严重症状在过去16小时内恶化，遂进行了急诊MT。血管内介入治疗实现了完全血管再灌注，患者意识突然恢复，转院4个月后改良Rankin量表评分为2分。
了解BA和AOP之间的解剖及血流动力学关系对于急性BAO的有效治疗很重要。特别是，尽管症状持续时间较长，但后循环的缺血性改变仍可能是可逆的。https://thejns.org/doi/10.3171/CASE25171
