Retrograde thrombectomy of basilar artery thrombus through the posterior communicating artery.

Transcirculation thrombectomy through the communicating arteries of the circle of Willis has been previously described as a bailout in cases where direct thrombectomy is not feasible.1-3 Here we present a unique case where a retrograde thrombectomy of the proximal basilar artery was performed using the right posterior communicating artery (PCOM) in a patient with bilateral occlusions of the vertebral arteries, believed to be chronic. This was done using a quadriaxial system with multiple concentric catheters to minimize the ledge effect and achieve smooth and safe transition of the catheters from anterior to posterior circulations. A combination of stent retrieval, aspiration and balloon occlusion guide catheters helped retrieve the thrombus, while minimizing emboli in new territory (ENT). The patient had complete resolution of symptoms. The thrombus is believed to be due to stasis at the vertebrobasilar junction and competing flow, hence, the patient was started on anticoagulation. (video 1)neurintsurg;neurintsurg-2021-017965v1/V1F1V1Video 1.