Mechanical Thrombectomy Using the Solitaire FR system for Occlusion of the Top of the Basilar Artery: Intentional Detachment of the Device after Partial Retrieval
A 64-year-old male presented with altered mental status. He was found unconscious and his last known normal time period was four hours previously. His initial NIHSS stroke score was 18. He did not have any known stroke risk factors. However, atrial fibrillation was seen at the time of his admission. Acute stroke MR revealed multi-territorial, wedge-shaped infarcts involving both cerebellar hemispheres and the left PCA territory. Subtle signal changes were also noted in the pons.\nAn urgent, right vertebral angiogram showed distal BAO with a filling defect showing a meniscus sign. () An oval-shaped filling defect was noted along the open arterial lumen when the SFR was placed (). We could pull down the device with the filling defect down to the distal VA level below the origin of the PICA without any fragmentation and/or migration of the clot distally. We decided to detach the stent part at that level ().\nAs the volume of the initial infarct was significant, aspirin monotherapy was started without anti-coagulation which could not be initiated due to combined gastro-intestinal tract bleeding during the acute phase. On his discharge from the intensive care unit, the patient was placed on aspirin and warfarin. After rehabilitation, he could walk with some assistance. His modified Rankin score at 90 days was 3.