Summary of Patients with Acute Vertebrobasilar Ischemic Stroke: Presentation, MR Imaging and Angiographic Findings, and Neurointervention
| Patient no./Age (y)/Sex | Presenting Symptoms | DWI and/or PWI Findings | DW-PW Mismatch | MRA Findings | Angiographic Findings | Treatment | Pre-TIMI | Post-TIMI |
|---|---|---|---|---|---|---|---|---|
| 1/50/M | Wallenberg syndrome followed 6 days later by right hemiparesis, slurred speech, and diplopia | Right PICA infarct, new left pontine infarct 6 days later | 7.1:22 | No right VA or BA flow, possible left VA stenosis | Occluded mid-basilar artery, nearly occluded right VA, pre-occlusive left VA origin | Tristar coronary stent at left VA origin, 14 mg tPA thrombolysis of BA | 1 | 2 |
| 2/64/M | Transient diplopia followed by acute onset of slurred speech and transient right leg weakness | Small left pontine lesion, bright on DWI | 0.8:131.4 | Right VA and mid-basilar stenosis | Severely stenotic non-dominant right VA perfusing the right PICA, pre-occlusive stenosis of left VA origin, BA occlusion | Tristar coronary stent at the left VA origin, 9 mg tPA thrombolysis of basilar at the level of PICA | 0 | 2 |
| 3/80/M | Dysarthria, weakness, dizziness; next a.m., inability to move out of bed, vomiting and unresponsive | Acute CVA: right pons, bilateral occipital lobes, rights thalamus | 12.1:49.1 | Stenosis of left cavernous ICA, occluded left ICA, decreased flow in left PCA | 90 95% right ICA stenosis, left ICA occlusion, severe stenosis in mid left SCA and left VA origin, basilar artery apex thrombosis, occluded right VA origin | 4 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 BA | 0 | 2 |
| 4/60/M | Acute stroke with left hemiparesis followed by coma 3 days later | Right thalamo-capsular and right pons, upper midbrain infarct | PWI not performed | Basilar 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 disease | Tetra coronary stent at right VA origin, 19.5 mg tPA, thrombolysis of BA with minimal dissolution of clot | 0 | 0 |
| 5/72/M | Diplopia and ataxia, 36-h duration, followed by coma | Small left pontine lesion | 0.4:174.1 | Distal basilar artery thrombosis | 80% stenosis, right PICA origin; 90%, right AICA; distal BA occlusion; PCA not seen; 40–50% stenosis, distal left CCA | AVE stent, right VA origin; 9 mg tPA and angioplasty of BA | 0 | 1 |
| 6/60/M | Headache, diplopia, vertigo, ataxia, acutely lethargic | Bilateral AICA distribution, small pons and midbrain, left occipital and corpus callosum, and left thalamus infarcts | 5.6:166.5 | No flow in BA | Left VA occlusion, high-grade stenosis with slow flow in right VA, no perfusion of BA | Vertebral origin stent, 9 mg tPA, proximal BA thrombolysis | 0 | 2 |
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.