Skip to main content

Advertisement

SpringerLink
Log in

Successful Treatment of Recurrent Basilar Artery Occlusion with Intra-Arterial Thrombolysis and Vertebral Artery Coiling in a Child

  • Practical Pearl
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Signs of brainstem ischemia in children may be subtle, and outcome following basilar artery occlusion is often poor. There currently are no guidelines in children regarding the best methods to diagnose and treat basilar artery occlusion.

Methods

Case report and literature review.

Results

We describe the presentation and management of recurrent basilar artery occlusion in a previously healthy 5-year-old boy with vertebral artery dissection. Treatment included emergent intra-arterial tPA and mechanical thrombolysis of basilar artery clot, followed by later coiling of the vertebral artery to prevent recurring episodes of basilar artery ischemia.

Conclusion

Management of brainstem stroke in children requires coordination of neurology, critical care, and interventional radiology services. Delayed intra-arterial thrombolysis and vertebral artery coiling can be successfully used to treat basilar artery occlusion and prevent the recurrence of brainstem ischemia in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rosman N, Adhami S, Mannheim G, et al. Basilar artery occlusion in children: misleading presentations, ‘locked-in’ state, and diagnostic importance of accompanying vertebral artery occlusion. J Child Neurol. 2003;18:450–62.

    Article  PubMed  Google Scholar 

  2. Ganesan V, Chong W, Cox T, et al. Posterior circulation stroke in childhood: risk factors and recurrence. Neurology. 2002;59:1552–6.

    PubMed  CAS  Google Scholar 

  3. Ferbert A, Brückmann H, Drummen R. Clinical features of proven basilar occlusion. Stroke. 1990;21:1135–42.

    Article  PubMed  CAS  Google Scholar 

  4. Cross D, Moran C, Akins P, et al. Relationship between clot location and outcome after basilar artery thrombolysis. Am J Neuroradiol. 1997;18:1221–8.

    PubMed  Google Scholar 

  5. Roach E, Golomb M, Adams R, et al. Management of stroke in infants and children. Stroke. 2008;39:2644–91.

    Article  PubMed  Google Scholar 

  6. Kirton A, Wong J, Mah J, et al. Successful endovascular therapy for acute basilar thrombosis in an adolescent. Pediatrics. 2003;112:e248–51.

    Article  PubMed  Google Scholar 

  7. Cognard C, Weill A, Lindgren S, et al. Basilar artery occlusion in a child: clot angioplasty followed by thrombolysis. Childs Nervous Syst. 2000;16:496–500.

    Article  CAS  Google Scholar 

  8. Bruno MA, Schnakers C, Damas F, et al. Locked-in syndrome in children: report of five cases and review of the literature. Pediatr Neurol. 2009;41:237–46.

    Article  PubMed  Google Scholar 

  9. Zoppo G, Saver J, Jauch E, et al. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator. Stroke. 2009;40:2945–8.

    Article  PubMed  Google Scholar 

  10. Adams H Jr, del Zoppo G, Alberts M, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke. 2007;38:1655–711.

    Article  PubMed  Google Scholar 

  11. Voetsch B, DeWitt D, Pessin M, et al. Basilar artery occlusive disease in the New England Medical Center posterior circulation registry. Arch Neurol. 2004;61:496–504.

    Article  PubMed  Google Scholar 

  12. Tan MA, Armstrong D, MacGregor D, et al. Late complications of vertebral artery dissection in children: pseudoaneurysm, thrombosis, and recurrent stroke. J Child Neurol. 2009;24:354–60.

    Article  PubMed  Google Scholar 

  13. Hacke W, Zeumer H, Ferbert A, et al. Intraarterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988;19:1216–22.

    Article  PubMed  CAS  Google Scholar 

  14. Brandt T, von Kummer R, Muller-Kuppers M, et al. Thrombolytic therapy of acute basilar artery occlusion: variables affecting recanalization and outcome. Stroke. 1996;27:875–81.

    Article  PubMed  CAS  Google Scholar 

  15. Chen H, Wu S, Lo M. Basilar artery occlusion in a teenaged boy treated with intra-arterial thrombolysis. Acta Neurol Taiwan. 2010;19:280–6.

    Google Scholar 

  16. Sungarian A, Duncan J III. Vertebrobasilar thrombosis in children: report of two cases and recommendations for treatment. Pediatr Neurosurg. 2003;38:16–20.

    Article  PubMed  Google Scholar 

  17. Larner A. Basilar artery occlusion associated with pathological crying: ‘folles larmes prodromiques’? Neurology. 1998;51:916–7.

    PubMed  CAS  Google Scholar 

  18. Yoshikawa H. Basilar artery infarction. Arch Dis Child. 2005;90:410.

    Article  PubMed  CAS  Google Scholar 

  19. Zaidat O, Tolbert M, Smith T, et al. Primary endovascular therapy with clot retrieval and balloon angioplasty for acute basilar artery occlusion. Pediatr Neurosurg. 2005;41:323–7.

    Article  PubMed  Google Scholar 

  20. Grigoriadis S, Gomori JM, Grigoriadis N, et al. Clinically successful late recanalization of basilar artery occlusion in childhood: what are the odds? Case report and review of the literature. J Neurol Sci. 2007;260:256–60.

    Article  PubMed  Google Scholar 

  21. Bhatt A, Naravetla B, Majid A, Kassab M, Gupta R. Treatment of a basilar artery occlusion with intra-arterial thrombolysis in a 3-year-old girl. Neurocrit Care. 2008;9:357–60.

    Article  PubMed  Google Scholar 

  22. Janmaat M, Gravendee L, Uyttenboogaart M, et al. Local intra-arterial thrombolysis in a 4 year old male with vertebrobasilar artery thrombosis. Dev Med Child Neurol. 2009;51:155–8.

    Article  PubMed  Google Scholar 

  23. Arnold M, Steinlin M, Baumann A, et al. Thrombolysis in childhood stroke: report of 2 cases and review of the literature. Stroke. 2009;40:801–7.

    Article  PubMed  CAS  Google Scholar 

  24. Taneja A, Hanna I, Holdgate A, et al. (2011) Basilar artery occlusion in a 14-year old female successfully treated with acute intravascular intervention: case report and review of the literature. J Paediatr Child Health. doi:10.1111/j.1440-1754.2010.01974.x.

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neurology, Northwestern University Feinberg School of Medicine, No. 51, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL, 60614-3394, USA

    John Condie

  2. Department of Pediatrics, Divisions of Neurology and Critical Care Medicine, Northwestern University Feinberg School of Medicine, No. 51, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL, 60614-3394, USA

    Mark S. Wainwright

  3. Departments of Radiology and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ali Shaibani

Authors
  1. John Condie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ali Shaibani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark S. Wainwright
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark S. Wainwright.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Condie, J., Shaibani, A. & Wainwright, M.S. Successful Treatment of Recurrent Basilar Artery Occlusion with Intra-Arterial Thrombolysis and Vertebral Artery Coiling in a Child. Neurocrit Care 16, 158–162 (2012). https://doi.org/10.1007/s12028-011-9579-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-011-9579-7

Keywords

Search

Navigation