Direct V2 vertebral artery puncture as rescue access for basilar thrombectomy: a technical note.

INTRODUCTION

Basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) can be complicated by unfavorable supra-aortic anatomy precluding conventional transfemoral or trans-radial access.

METHODS

We describe direct percutaneous vertebral artery (VA) puncture as a rescue strategy in three patients with BAO in whom conventional access failed because of chronic vertebral artery occlusion. Roadmap-guided puncture of the V2 segment allowed stent-retriever thrombectomy through a 4 F sheath.

RESULTS

Reperfusion (mTICI 2b-2c) was achieved in all three patients, with favorable outcomes (6-month mRS 0-1) and no major access-site complications.

CONCLUSION

Direct V2 vertebral artery puncture is a viable, technically demanding rescue option for BAO, reserved for carefully selected patients at highly experienced comprehensive stroke centers.