The basilar artery is the unpaired vessel of the posterior cranial circulation, supplying the pons, cerebellum, midbrain, thalamus, and occipital lobes through its branches. Basilar artery occlusion is a catastrophic stroke with high mortality and morbidity, producing the locked-in syndrome when the pons is infarcted. Endovascular thrombectomy for basilar occlusion is now performed up to 24 hours from symptom onset in selected patients.
| Origin | Union of the two vertebral arteries at the pontomedullary junction |
|---|---|
| Course | Ascends along the anterior surface of the pons in the prepontine cistern, gives off cerebellar and pontine branches, and divides at the pontomesencephalic junction into the two posterior cerebral arteries |
| Branches |
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Vertebrobasilar TIAs from basilar system disease produce the 5 Ds and 3 Ns: Dizziness, Diplopia, Dysarthria, Dysphagia, Drop attacks, and Nausea, Numbness, Nystagmus. Basilar tip aneurysms are the most surgically complex intracranial aneurysms, located between both posterior cerebral arteries and both superior cerebellar arteries. The basilar artery is accessible endovascularly via the vertebral arteries for thrombectomy and aneurysm coiling.
Posterior circulation catastrophic stroke producing coma, quadriplegia, and locked-in syndrome with high mortality, managed with emergent endovascular thrombectomy within 24 hours of onset.
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