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Basilar Artery Thrombosis in a Child Treated With Intravenous Tissue Plasminogen Activator and Endovascular
Jakob Fink1, Laura Sonnenborg, Line Lunde Larsen
11Department of Radiology, Roskilde Hospital, Roskilde, Denmark.
Insights
Pediatric basilar artery occlusion is rare but serious. This case shows that combining intravenous thrombolysis and mechanical thrombectomy, known as bridging therapy, can be safe and effective for children, leading to full recovery.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Interventional Neuroradiology
Background:
- Basilar artery occlusion (BAO) in children is a rare neurological emergency.
- High mortality and morbidity rates are associated with BAO if prompt recanalization is not achieved.
- Prompt treatment is crucial to prevent extensive brainstem infarction.
Purpose of the Study:
- To report the first case of pediatric basilar artery occlusion treated with bridging therapy.
- To evaluate the safety and efficacy of bridging therapy in a pediatric patient with BAO.
- To highlight the potential of bridging therapy in managing this rare condition.
Main Methods:
- A pediatric patient presenting with "top-of-the-basilar" syndrome was treated.
- Intravenous thrombolysis with tissue plasminogen activator was administered.
- Mechanical thrombectomy using a Solitaire stent was performed for recanalization.
Main Results:
- Successful clot removal and recanalization of the basilar artery were achieved 4 hours after stroke onset.
- The patient experienced a full clinical recovery.
- Bridging therapy was demonstrated to be safe and effective in this pediatric case.
Conclusions:
- Bridging therapy, combining intravenous thrombolysis and mechanical thrombectomy, offers a promising treatment strategy for pediatric basilar artery occlusion.
- Early diagnosis within the 4.5-hour thrombolysis window is critical for successful outcomes.
- This case establishes a precedent for considering bridging therapy in similar pediatric cases.
Abstract:
Basilar artery occlusion in children is rare. It has a high mortality and morbidity if recanalization is not achieved before extensive brainstem infarction has occurred. An 11-year-old boy presented with a clinical and radiological "top-of-the-basilar" syndrome. Intravenous tissue plasminogen activator was administered, and the patient was immediately referred to the regional stroke center. Subsequent mechanical thrombectomy using a Solitaire stent (Solitaire FR stent; ev3, Irvine, CA, USA) resulted in clot removal and recanalization of the basilar artery 4 hours after stroke onset. The patient made a full clinical recovery. To the authors' knowledge this is the first report on basilar artery occlusion in a child treated with "bridging" therapy, the combination of intravenous thrombolysis and endovascular thrombectomy. If the diagnosis can be made within the time window for intravenous thrombolysis (4.5 hours), the present case suggests that bridging therapy in pediatric basilar artery occlusion can be safe and effective.
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