Summary of Patients with Acute Vertebrobasilar Ischemic Stroke: Presentation, MR Imaging and Angiographic Findings, and Neurointervention

Patient no./Age (y)/SexPresenting SymptomsDWI and/or PWI FindingsDW-PW MismatchMRA FindingsAngiographic FindingsTreatmentPre-TIMIPost-TIMI
1/50/MWallenberg syndrome followed 6 days later by right hemiparesis, slurred speech, and diplopiaRight PICA infarct, new left pontine infarct 6 days later7.1:22No right VA or BA flow, possible left VA stenosisOccluded mid-basilar artery, nearly occluded right VA, pre-occlusive left VA originTristar coronary stent at left VA origin, 14 mg tPA thrombolysis of BA12
2/64/MTransient diplopia followed by acute onset of slurred speech and transient right leg weaknessSmall left pontine lesion, bright on DWI0.8:131.4Right VA and mid-basilar stenosisSeverely stenotic non-dominant right VA perfusing the right PICA, pre-occlusive stenosis of left VA origin, BA occlusionTristar coronary stent at the left VA origin, 9 mg tPA thrombolysis of basilar at the level of PICA02
3/80/MDysarthria, weakness, dizziness; next a.m., inability to move out of bed, vomiting and unresponsiveAcute CVA: right pons, bilateral occipital lobes, rights thalamus12.1:49.1Stenosis of left cavernous ICA, occluded left ICA, decreased flow in left PCA90 95% right ICA stenosis, left ICA occlusion, severe stenosis in mid left SCA and left VA origin, basilar artery apex thrombosis, occluded right VA origin4 mm × 3.8 cm Guidant Tristar stent in right CCA and 6 mm × 2 cm wall stent in left SCA, 24 mg tPA thrombolysis of BA02
4/60/MAcute stroke with left hemiparesis followed by coma 3 days laterRight thalamo-capsular and right pons, upper midbrain infarctPWI not performedBasilar thrombosis>90% stenosis, right VA origin; occluded left VA; occlusion of BA at junction of proximal and mid-third; left subclavian steal; 70–80% stenosis, proximal left SCA; >90% stenosis, diffuse and severe atheromatous diseaseTetra coronary stent at right VA origin, 19.5 mg tPA, thrombolysis of BA with minimal dissolution of clot00
5/72/MDiplopia and ataxia, 36-h duration, followed by comaSmall left pontine lesion0.4:174.1Distal basilar artery thrombosis80% stenosis, right PICA origin; 90%, right AICA; distal BA occlusion; PCA not seen; 40–50% stenosis, distal left CCAAVE stent, right VA origin; 9 mg tPA and angioplasty of BA01
6/60/MHeadache, diplopia, vertigo, ataxia, acutely lethargicBilateral AICA distribution, small pons and midbrain, left occipital and corpus callosum, and left thalamus infarcts5.6:166.5No flow in BALeft VA occlusion, high-grade stenosis with slow flow in right VA, no perfusion of BAVertebral origin stent, 9 mg tPA, proximal BA thrombolysis02
  • Note.—DWI indicates diffusion-weighted imaging; PWI, perfusion-weighted imaging; DW-PW mismatch, diffusion-perfusion mismatch; MRA, MR angiography; TIMI, thrombolysis in myocardial infarction; Pre-TIMI, TIMI grade before treatment; post-TIMI, TIMI grade after treatment; PICA, posterior inferior cerebellar artery; VA, vertebral artery; BA, basilar artery; tPA, tissue plasminogen activator; CVA, cerebrovascular accident; ICA, internal carotid artery; PCA, posterior cerebral artery; SCA, superior cerebellar artery; CCA, common carotid artery; AICA, anterior inferior cerebellar artery.