Successful Recovery After Delayed Thrombectomy for Acute Basilar Artery Occlusion: A Case Report

Top of the Basilar Syndrome (TOBS) is a rare neurological condition caused by occlusionof the distal basilar artery, often resulting in significant morbidity. TOBS is particularlychallenging to diagnose in younger patients with atypical risk factors. A 34-year-old man presented with vertigo following strenuous exercise. Initial misdiagnosesdelayed treatment, and subsequent imaging revealed left vertebral artery dissectionand basilar artery occlusion. Endovascular thrombectomy performed 41 hours and45 minutes after symptom onset achieved a Thrombolysis in Cerebral Infarction(TICI) score of 2B. Despite complications, including hydrocephalus and pneumonia,multidisciplinary management led to significant recovery, with the patient’s modifiedRankin Scale (mRS) score improving from 4 at discharge to 1 at one year. This caseunderscores the importance of clinical vigilance, advanced imaging, and endovascularthrombectomy in managing TOBS. Even with delayed intervention, multidisciplinarycare can facilitate favorable outcomes in young patients with rare presentations.