Basilar Artery Thrombectomy After TEVAR.

Objective: Stroke following TEVAR is an important cause of morbidity and mortality. Many published series have demonstrated its association with mortality. Our clinical case presents diagnostic, treatment strategy and neurological result after basilar artery thrombectomy in patient shortly after TEVAR operation of thoracic aorta aneurysm with left subclavian artery coverage.

Materials and Methods: 67 years old male patient was hospitalized due to acute instability, sensitive loss 5 days after TEVAR operation.

Results: Patient was hospitalized 3 hours after acute onset of the symptoms. In non-enhanced CT hiperdense artery of left posterior cerebral artery was noted. On CTA prosthesis over the left carotid artery and left subclavian artery was visualized with simultaneous occlusion at the level of basilar artery. Patient received acute intravenous thrombolysis and transferred to interventional radiology department. Only possible access was performed by left brachial artery. After selective left vertebral artery catheterisation and angiography, occlusion of basilar artery tip was found. Using stent retriever with two accesses, basilar tip was recanalized with complete revascularisation, TICI 3. Patient was extubated with slight neurological deficit, NIHSS 4.

Conclusions: Thrombectomy after TEVAR is technically challenging procedure with necessity of CTA for visualization of aortic arch. Cerebral stroke is common complication after TEVAR, especially after left subclavian artery coverage.