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AJNR - American Journal of Neuroradiology

Published ahead of print on August 7, 2008
doi: 10.3174/ajnr.A1243

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Management and Clinical Outcome of Acute Basilar Artery Dissection

B.M. Kim^a, S.H. Suh^d, S.I. Park^e, Y.S. Shin^f, E.C. Chung^a, M.H. Lee^a, E.J. Kim^g, J.S. Koh^h, H.-s. Kangⁱ, H.G. Roh^j, Y.S. Won^b, P.-W. Chung^c, Y.-B. Kim^c and B.C. Suh^c

^a Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
^b Department of Neurosurgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
^c Department of Neurology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
^d Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
^e Department of Radiology, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
^f Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea
^g Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
^h Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, Korea
ⁱ Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
^j Department of Radiology, Konkuk University Hospital, Seoul, Korea

View larger version (181K): [in this window] [in a new window]   Fig 1. A 42-year-old man presenting with progressive deterioration of consciousness. CT angiogram (A) and vertebral angiogram (B) reveal near-occlusion of the basilar artery by an intramural hematoma (arrows). C, After emergency stent insertion, the basilar artery and left posterior cerebral artery are visualized, but the right posterior cerebral artery is not seen on vertebral angiogram. D, A 2-week (not seen) and 18-month follow-up vertebral angiogram show a patent basilar artery and its branches. The patient had a favorable outcome (mRS score, 0).

View larger version (56K): [in this window] [in a new window]   Fig 2. A 30-year-old man presenting with signs of stem compression 3 years after initial presentation of brain stem infarction. A, Initial MR angiogram reveals focal asymmetric dilation in the distal basilar artery. B, CT angiogram 3 years after initial MR imaging as a result of brain stem compression. A large asymmetric pseudoaneurysm is demonstrated in the same location. C, Vertebral angiogram in lateral projection after overlapping double-stent deployment shows flow redirection through the stent and the basilar artery with stasis of contrast media in the pseudoaneurysmal sac (arrows). D and E, A 4-month follow-up vertebral artery angiogram (D) and right internal carotid artery angiogram (E) reveal occlusion of the basilar artery and hypertrophied right posterior communicating artery (arrow), which supplies the distal basilar artery and its branches.

View larger version (44K): [in this window] [in a new window]   Fig 3. A 48-year-old woman presenting with a subarachnoid hemorrhage. A, Initial vertebral angiogram reveals focal asymmetric dilation of the basilar artery. B, Minimal contrast media filling remains in the coil-embolized pseudoaneurysmal sac outside the stents. C, A 9-month follow-up angiogram shows complete obliteration of the pseudoaneurysmal sac and minimal contrast media filling portion in the right side outside the stents. Note the gap (arrow) between the stents and contrast media filling portion.