Floating thrombus- basilar artery occlusion
Authors
Samantha Kumar, Dr Sunetra D Phulsunge, Dr Vibhor Pardasani, Rakesh SinghFiles
Key Information
Journal
Published in Vol. 68 No. 1 (2026) of Bombay Hospital Journal.
Bombay Hospital Journal (BHJ) is a peer-reviewed quarterly published Print and Online journal. It is an official Journal of Bombay Hospital institute of medical sciences. The aim of BHJ is to improve medical care by publishing sound scientific articles (both research and practice papers) and focusing on topics that are of great importance to its readership.
Editor-in-Chief- Dr Satish Vasant Khadilkar
About the JournalAbstract
Aim
The treatment of Basilar artery occlusion (BAO) with low NIHSS score requires to be individualized to each patient
Background
Basilar artery occlusion represents a small proportion of strokes worldwide but can have catastrophic presentations. Recent trials for BAO have studied the benefits of endovascular treatment (EVT) over intravenous thrombolysis (IVT) and have concluded that EVT has better mortality and morbidity outcomes. However, the management of BAO with lower NIHSS scores may become risky as the complications of the said treatment may outweigh the benefits.
Case description
We present a 54-year-old lady who presented with dizziness and hemiplegia which resolved within 1 hour. She had hypertension, mild left facial weakness and NIHSS score of 1 on presentation. MRI Brain revealed an acute focal left lateral medullary infarct, and angiogram showed a basilar artery thrombosis with distal basilar artery flow. She was started on dual antiplatelet therapy, low molecular weight heparin and statin. Cerebral DSA revealed a floating thrombus within the basilar artery and left vertebral artery V4 segment stenosis with normal flow in the distal basilar artery. As the patient had mild symptoms, she was discharged on oral anticoagulant and single antiplatelet therapy. She underwent stenting of the Vertebral artery V4 segment, 2 months later as she had recurrent posterior circulation transient ischemic attacks.
Conclusion
All basilar artery occlusions need not require immediate endovascular thrombectomy and may be managed conservatively initially with anti-coagulation and antiplatelet therapy.
References
References
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License
Copyright (c) 2026 Bombay Hospital Journal
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© The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons. org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated.
