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FIG 2. Case 2, a 67-year-old man with acute basilar dissection.
A, Anteroposterior right vertebral angiogram (before superselective catheterization), showing occlusion of the right posterior cerebral and left superior cerebellar arteries with small stumps. This was believed to be secondary to thromboembolism. Irregularity of the intradural right vertebral artery, first thought to represent atherosclerosis, may be secondary to dissection. In retrospect, a small intimal flap was visible in the midbasilar segment on the lateral view.
B, After 30 mg of t-PA, there was no improvement; however, following blind catheterization of the right PCA, the right PCA and left SCA show normalized flow.
C, Lateral right vertebral injection, clearly showing a linear filling defect of the basilar artery indicating dissection. This had been present before intervention but was unrecognized until remasking and pixel shifting were performed on the initial runs.
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