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Introduction: basilar artery thrombosis (BAT) is the cause of about 1% of ischemic strokes (IS). About 27% of strokes in posterior circulation are associated with BAT. Mortality in BAT without recanalization reaches 85-95%. In 80.7% of patients with BAT at the onset of disease a decrease in level of consciousness is observed, in 34% of them – coma.

Aim: was to show the possibility of performing thrombectomy (TE) in patients with BAT and reduced level of consciousness as the only effective way to prevent death in this pathology.

Materials and methods: two case reports of successful TE from basilar artery in patients with IS and decrease in level of wakefulness to coma, are presented.

Results: article describes two successful cases of TE in patients with angiographically confirmed BAT and decrease in the level of consciousness to moderate coma at the onset of disease. In two presented patients, TE made a complete restoration of BA blood flow. Good clinical outcomes were noted in both patients by 90th day of disease (modified Rankin scale 0-2 points). The Rivermead mobility index at discharge from hospital was 14 points, and the Bartel index by 90th day – complete independence from others in everyday life (from 90 to 100 points), and that once again indicates that TE in BAT is not only a life-saving procedure, but significantly improves functional and clinical outcomes of disease.

Conclusions: basilar artery thrombosis is a life-threatening condition that requires urgent reperfusion therapy as the only effective method of treatment. Endovascular treatment for basilar artery thrombosis should be considered in all patients, regardless the decrease in the level of consciousness at the onset of disease, because thrombectomy is a life-saving procedure.




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The review is devoted to possibilities of ultrasound and functional diagnostic methods in the diagnosis of ischemic stroke of unknown etiology. Main causes of cryptogenic ischemic stroke are highlighted in the article. Advances in high resolution ultrasound of extracranial and intracranial vessels and of the heart, prolonged heart rhythm monitoring are instrumental techniques to identify arterial and cardiac hidden causes of stroke. We reviewed literature, on the basis of available data, designed a diagnostic algorithm for patients with patent foramen ovale (PFO) and risk of embolism from atherosclerotic plaque. 



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Thrombolytic therapy (TLT) is the most efficient method of reperfusion therapy in ischemic stroke (IS), considerably increasing the number of patients with good functional restoration obtained. Carrying out selective intraarterial TLT (IA TLT) is feasible within the framework of a wider therapeutic window (up to 6-8 hours from the onset of the disease) under angiographic control and a possibility of individual dosing of a fibrinolytic employed. The present study demonstrated high efficiency of selective IATLT based on two clinical examples of patients presenting with IS. In the first case, a 55-year-old male patient with occlusion of M1 segment of the right median cerebral artery (MCA) and a baseline NIH score equalling 13 underwent IA TLT preformed 7 hours after the onset of IS, which led to complete recanalization of the vessel after 40 minutes, and resulted in a considerable clinical improvement (8 points by the NIH scale after TLT). The second case describes a 64-year-old female patient presenting with segment C7 stenosis of the left internal carotid artery and occlusion of segment M1 2 of the left MCA (20 points by the NIH scale). Carrying out IA TLT also promoted restoration of the blood flow after 60 minutes and restoration of the disordered functions (NIHSS score 14). Hence, the described examples demonstrate high efficacy of intra-arterial thrombolysis in management of patients with ischemic stroke.



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