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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:1823-1826, October 2003
© 2003 American Society of Neuroradiology

Case Report
INTERVENTIONAL

Perfusion- and Diffusion-Weighted MR Imaging–Guided Therapy of Vertebral Artery Dissection: Intraarterial Thrombolysis through an Occipital Vertebral Anastomosis

Lucas Restrepo^a, Gustavo Pradilla^c, Rafael Llinas^a and Norman J. Beauchamp^b

^a Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
^b Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
^c Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland

Address correspondence and reprint requests to Dr. Lucas Restrepo, Department of Neurology, Division of Vascular Neurology, Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 5–181, Baltimore, MD 21287-6953

Summary: Management of arterial dissections can be particularly challenging. We report a case of vertebral artery dissection in which perfusion- and diffusion-weighted MR imaging findings suggested the presence of salvageable tissue, despite that the patient had symptoms for more than 40 hours. Direct access to the distal vascular territory was unattainable, and the presence of collateral circulation through an occipital vertebral anastomosis provided the only pathway to administer intraarterial thrombolysis. This case demonstrates that perfusion- and diffusion-weighted MR imaging can be instrumental in the selection of candidates for aggressive stroke therapy. Arterial anastomoses can provide alternate access to ischemic vascular beds and merit careful evaluation during intraarterial thrombolysis.

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