Basilar artery occlusion in a teenaged boy treated with intra-arterial thrombolysis

Intra-venous thrombolysis (IVT) with recombinant tissue plasminogen activator (r-tPA) is the standard treatment of acute ischemic stroke in Taiwan. However, there are many limitations to this treatment, such as the three-hour therapeutic time window and an age limit of 18 to 80 years.

We reported a 15-year-old boy with vertebrobasilar artery total occlusion that presented with a sudden onset of consciousness disturbance. The accompanying findings were clonic-jerky movements of the 4 limbs and startled gazing for 10 minutes. Consciousness soon returned, but left hemiplegia and bilateral total ophthalmoplegia were noted. Brain computed tomography (CT) angiography revealed basilar artery total occlusion. Emergency intra-arterial thrombolysis (IAT) with urokinase was performed 5.3 hours after the onset. The course was smooth and the patient recovered well. He was free of symptoms at clinical follow up 30 months after the IAT.

To the best of our knowledge, this is the youngest reported patient with complete basilar artery occlusion to have received IAT and achieve a complete recovery in Taiwan. Our experience might suggest that IAT is an alternative treatment for patients having acute ischemic strokes but exceeding the three-hour time window for IVT with r-tPA, even in adolescence.