Title : A case of acute basilar artery territory infarct in an 86-year-old with intracranial atherosclerotic stenosis managed with balloon angioplasty and tirofiban infusion
Abstract:
In basilar artery occlusion, clinical presentation may range from mild transient symptoms to a devastating stroke with high morbidity and mortality. This paper presents a case of an 86-year-old female who developed persistent dizziness and vomiting, with a National Institutes of Health Stroke Scale (NIHSS) score of 15, and was later found to have basilar artery occlusion. Since she arrived at the emergency department within the golden period, she was given intravenous tenecteplase 3 hours and 51 minutes post-ictus; however, there was no significant neurologic improvement, with her NIHSS score decreasing only from 15 to 14. Following intravenous thrombolysis, mechanical thrombectomy was performed. Given the presence of persistent thrombus with underlying stenosis, balloon angioplasty using a 2.5 mm balloon was carried out, resulting in re-establishment of flow and improved caliber of the posterior circulation. Adjunctive intra-arterial tirofiban infusion was also performed, successfully restoring vessel patency. The patient improved from an National Institutes of Health Stroke Scale (NIHSS) score of 15 to 0, was discharged in stable condition, and remained symptom-free at both two-week and six-month follow-ups. This case is particularly relevant because balloon angioplasty is rarely performed in the posterior circulation, and its successful use in this elderly patient underscores its potential role as a rescue strategy in selected cases of basilar artery occlusion. Furthermore, this report highlights that advanced age alone should not preclude endovascular therapy, as carefully selected octogenarians may achieve excellent clinical outcomes with individualized treatment strategies.
