acute stroke therapy

Stent-retriever devices achieve high rates of recanalisation in acute ischaemic stroke with proximal arterial occlusion. In the setting of distal occlusion such as M2 middle cerebral artery occlusion, stent-retrievers seem safe and recanalisation may double the chances of achieving a favourable outcome. In posterior circulation, technical feasibility, efficacy and safety of stent-retrievers are poorly documented. A 61-year-old man presented with an ischaemic stroke secondary to acute basilar artery occlusion. Mechanical thrombectomy with the Solitaire device was performed and complete recanalisation of basilar artery was achieved; however, a right P2 posterior cerebral artery occlusion was observed due to clot fragmentation. A complete distal artery recanalisation was achieved rapidly after a second passage of the stent-retriever. MR imaging on day 1 revealed a similar volume ischaemic lesion without haemorrhagic event. This case illustrates the feasibility, efficacy and safety of distal P2 posterior circulation occlusion recanalisation with a stent-retriever.