Related Experiment Video
Updated: May 28, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular treatment of basilar artery occlusion by manual aspiration thrombectomy
Brian T Jankowitz1, Aitziber Aleu, Ridwan Lin
1Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Aspiration thrombectomy using a 4.3F catheter effectively recanalized basilar artery occlusions in six stroke patients. This innovative technique led to survival and independence in most patients, offering promising results.
Area of Science:
- Neuroendovascular therapy
- Cerebrovascular disease management
- Interventional neurology
Background:
- Basilar artery occlusion (BAO) is a severe stroke subtype with historically poor outcomes.
- Current intravenous and intra-arterial therapies for BAO show limited efficacy.
- There is a critical need for more aggressive and innovative treatment strategies for BAO.
Observation:
- A cohort of six patients with basilar artery occlusion underwent treatment with intra-arterial tissue plasminogen activator and mechanical thrombectomy.
- Manual syringe aspiration via a 4.3F catheter was employed when initial thrombectomy passes were insufficient.
- All patients treated with aspiration thrombectomy achieved recanalization.
Findings:
- Five of six patients achieved excellent angiographic outcomes (TIMI3/TICI3 flow).
- One patient had partial recanalization (TIMI2/TICI2B) with persistent thrombus.
- All patients survived, with five out of six achieving functional independence at 3 months (modified Rankin Scale 0-2).
Implications:
- Manual aspiration thrombectomy through a 4.3F catheter is a feasible technique for BAO recanalization.
- This approach demonstrates potential for improving clinical outcomes in basilar artery occlusion.
- Further research with larger cohorts is warranted to validate these findings.
Background And Purpose:
Basilar artery occlusion remains one of the most devastating subtypes of stroke. Intravenous and intra-arterial therapy have altered the natural history of this disease; however, clinical results remain poor. Therefore, exploring more aggressive and innovative management is warranted.
Methods:
Six consecutive patients presenting with a basilar artery occlusion were treated with the same general algorithm of intra-arterial tissue plasminogen activator and mechanical thrombectomy with the Merci retrieval system. If complete recanalization was not achieved after two passes, manual syringe aspiration through a 4.3F catheter was employed.
Results:
All interventions utilizing aspiration thrombectomy resulted in recanalization, with five out of six cases displaying TIMI3/TICI3 flow and one patient resulting in complete recanalization of the basilar artery with persistent thrombus in one P2 segment (TIMI2/TICI2B). All patients survived, with five out of six independent in activities of daily living at 3 months (mRS 0-2).
Conclusions:
Our small case series indicates that aspiration thrombectomy performed manually through a 4.3F catheter can facilitate recanalization of basilar artery occlusion with acceptable clinical outcomes.
