Basilar artery thrombosis clinical meet slideshare. Pediatric stroke is an underrecognized, potentially treatable cause of childhood neurologic disease. Acute basilar artery thrombosis is an infrequent but catastrophic subtype of posterior circulation ischemic stroke that carries a mortality rate of 80%90% without treatment. Acute basilar artery occlusion is a rare stroke syndrome comprising only 3% of all ischemic strokes 1,2. The basilar artery terminates by splitting into the left and right posterior cerebral arteries. Acute interventions with both chemical and mechanical thrombolysis techniques can improve outcomes in adults with arterial thrombosis of the posterior cerebral circulation. The balloon occlusion also is believed to prevent the formation of a giant aneurysm, which presents as a mass lesion 1,3,8. Cerebral thrombosis definition of cerebral thrombosis by.
However, the advent of highquality, reliable, and noninvasive technology eg, magnetic resonance imaging mri has made its diagnosis possible even in subjects with mild symptoms see the image below. A 53yearold man presented with newonset severe rightsided weakness, dysarthria, dysphagia, and nystagmus. Occlusion due to atherosclerotic disease is most prevalent in patients of advanced age, usually in the sixth and seventh decades of life. Basilar artery thrombosis statpearls ncbi bookshelf.
Methods data from the madrid stroke network multicenter prospective registry were analyzed, including baseline characteristics, procedure. In the fourth patient basilar artery occlusion and a large pontine infarct were evident by magnetic resonance imaging and angiography. Endovascular thrombectomy for acute basilar artery. Clinical diagnostics, therapy and outcome after basilar artery. Background and purpose basilar artery occlusion bao is an infrequent form of acute stroke, which invariably leads to death or longterm disability if not recanalized. Involvement of major cerebral vessels is rare and basilar artery thrombosis has not been reported in fungal meningitis secondary to candida infection. It is one of the posterior circulation infarctions. This article discusses the case of a 40yearold man with basilar artery thrombosis, which, after numerous investigations, was found to be attributable to cocaine use. Bao is characterized by bad prognosis and high death rate, which is about 7591%.
Objective to compare patients outcome, relative merits of achieving recanalization, and predictors of futile recanalization fr. Acute basilar artery thrombosis is a devastating disease rarely encountered in children. The basilar artery is a vital vessel contributing to the posterior cerebral circulation. The outcome and mortality associated with bao are worse than those associated with anterior circulation stroke. Arteriosclerosis may be hereditary or may be brought on by diabetes mellitus. Top of the basilar syndrome radiology reference article. Basilar artery thrombosis, basilar artery occlusion, thrombolysis, stroke. Achieving timely vascular recanalization is the aim of treatment 5. Basilar artery thrombosis richardson 2001 emergency. Endovascular treatment of basilar artery thrombosis. To provide more data on the outcome of conventional treatment. Other neurological disorders such as seizure or basilar migraine might mimic stroke attack. Pontine arteries, anterior inferior cerebellar aica and superior cerebellar arteries, and terminal. Webmd explains basilar migraines, a form of intense headache, including symptoms, causes, diagnostic tests, and treatments.
In this case the end organ damage is already apparent. Basilar artery fenestration is an uncommon congenital dysplasia and may be associated with ischaemic stroke. E in a 73yearold man with proximal basilar artery occlusion, right carotid angiography shows filling of the posterior cerebral arteries, the distal basilar artery, and the superior cerebellar arteries from the anterior cerebral circulation via the posterior communicating artery. Jan 11, 2019 acute basilar artery thrombosis is associated with a poor prognosis. Posterior circulation infarct was suspected and mri showed a thrombus in a previously characterized dolichoectatic basilar artery aneurysm. Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intraarterial thrombolysis. One patient had preangiographic computed tomographic ct received november 12, 1996. Relationship between clot location and outcome after basilar. Objective to compare patients outcome, relative merits of achieving recanalization, and predictors of futile recanalization fr between bao and anterior circulation large vessel occlusion aclvo mt.
Basilar artery occlusion has poor outcome in adults. Recently our study group reported the results of the basilar artery international cooperation study basics, a prospective registry of patients with an. We present a case of a previously healthy 36yearold man who presented with vertigo and vomiting. Basilar artery thrombosis a ticking time bomb medcrave online. The majority of cases are due to thrombosis due to atherosclerotic disease, but can also be secondary to cardioembolic or infectious sources.
The lack of collateral information regarding illicit drug use during the. Basilar artery occlusion in adults is a devastating event, with a mortality rate of 8392%5. Although these may occur anywhere, each of these have predilections for different segments of the basilar artery. A hyperdense basilar artery is a common feature on ct scans of patients presenting with an early clinical diagnosis of thrombosis. The limited knowledge on the outcome after a conventional treatment approach comes from a few small case. B recanalization of basilar artery after intraarterial thrombolytic therapy and mechanical aspiration. Acute basilar artery occlusion radiology reference article. Deployment of six selfexpanding intracranial stents right p1 to left v3 resulted in recanalization timi 3. Fortyfive patients mean age, 59 years with basilar artery embolism participated in the study. Mechanical thrombectomy for basilar artery thrombosis.
Basilar artery occlusion is a most devastating form of stroke, and the current practice is to reverse it with revascularization therapies. A angiography of right vertebral artery showing basilar artery occlusion arrow. Treating the most feared and devastating strokes sciencedaily. Among the most feared and devastating strokes are ones caused by blockages in the brains critical basilar artery system.
The treatment of ba occlusion is challenging and must be initiated rapidly to prevent irreversible cerebral damage. Basilar artery stroke in childhood goeggel simonetti 20. The diagnosis may be difficult and need close clinicoradiological correlation. Basilar artery international cooperation study full text. Imaging in acute basilar artery thrombosis springerlink. Coronary thrombosis, arterial thrombosis in a coronary artery, is a complication of coronary atherosclerosis. The mortality has been estimated as high as 90% without acute intervention. Vertebral artery thrombosis is a potentially lifethreatening vascular event that can occur after injury to the cervical spine, vertebral artery dissection, but also surgical intervention. Heralding manifestations of basilar artery occlusion with. Of particular relevance to emergency medicine is the recognition and considera. When the vertebral artery is occluded, symptoms arise depending on which part of the brain is affected by ischemia. Jan 09, 20 among the most feared and devastating strokes are ones caused by blockages in the brains critical basilar artery system. Initial attempts to perform mechanical thrombectomy mt via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery va was occluded at its origin and the right va terminated in the posterior inferior cerebellar artery territory, without contribution to. Pdf basilar artery occlusion is a potentially lifethreatening subset of.
This case highlights the need for a high index of suspicion to make a diagnosis of lockedin syndrome in the emergency department, especially in young patients with no apparent risk factors for an. When a blood vessel a vein or an artery is injured, the body uses platelets thrombocytes and fibrin to form a blood clot to prevent blood loss. In this issue of the lancet neurology, schonewille and colleagues2 report novel, contemporary, robust, and generalisable evidence about the prognosis of symptomatic basilar artery occlusion and the use and. Nov 20, 2012 we performed a literature search using pubmed, embase, web of science, and the cochrane library with the search terms basilar artery obstruction, basilar artery occlusion, basilar artery thrombus, and basilar artery stroke, limited to humans and children, as well as the combination of paediatric stroke and. The main types of arterial thrombosis are related to arteriosclerosis, although thrombosis can also result from infection or from injury to an artery. However, identifying it correctly can be a diagnostic challenge for the. Acute stroke caused by basilar artery occlusion bao has devastating effects on patients. Recanalization treatments in basilar artery occlusion. Basilar artery thrombosis may explain as many as 27% of ischemic.
Vasculitic basilar artery thrombosis in chronic candida. The glasgow coma scale gcs score on admission was free access. Heralding manifestations of basilar artery occlusion with lethal or. Basilar artery thrombosis and occlusion causes only about 3% of ischaemic strokes1 but contributes substantially to the morbidity of patients and to the anxiety of their clinicians. Basilar artery occlusion bao is a rare cause of stroke, occurring in about 1% of all the cases. Delayed treatment of basilar thrombosis in a patient with. Endovascular thrombectomy for acute basilar artery occlusion. Even when a blood vessel is not injured, blood clots. We compared outcomes and procedural complications of mt in bao with anterior circulation occlusions. Acute occlusion of the basilar artery may cause brainstem or thalamic ischemia or infarction. Materials and methods from december 1992 through may 1996, 20 of 22 patients with angiographically confirmed basilar artery thrombosis were treated with intraarterial urokinase. Here we present the first case of delayed intraarterial thrombolysis of a basilar artery thrombosis associated with a large saccular.
Cocaineinduced acute fatal basilar artery thrombosis. Pdf on jan 1, 2009, salvador cruzflores and others published basilar artery thrombosis find, read and cite all the research you need on researchgate. Basilar artery thrombosis is an infrequent but important neurological emergency requiring early diagnosis and treatment. Therapy of basilar artery occlusion stroke aha journals. Ct and mr studies in 11 patients with clinical diag. Pharmacological thrombolysis, intravenous or intraarterial, has been adjuncted or replaced with invasive, endovascular thrombectomy procedures. Conventional stroke treatment with intravenous thrombolysis ivt is thought to be less effective in large vessel occlusion such as bao due to a higher clot burden 4. Noncontrast brain computed tomography ct revealed a hyperdense basilar artery, and ct cerebral angiography confirmed basilar artery thrombosis. The natural history of vertebral basilar arterial disease is frequently benign. Mri showed posterior circulation territory infarction. Basilar artery thrombosis was confirmed by pathological study in all these patients. The omission is important to point out, as basilar artery thrombosis is a potentially catastrophic condition that is often missed at both clinical and radiologic assessment.
The objective of this study was to clarify the clinical and radiologic features, risk factors, and prognosis of basilar embolism without permanent basilar artery occlusion. This results in bilateral thalamic ischemia due to occlusion of perforator vessels. Endovascular treatment of basilar artery occlusion by manual aspiration thrombectomy. The basics of treating symptomatic basilar artery thrombosis. Uncommon and in most cases fatal, basilar artery thrombosis is a devstating diagnosis. An individual in their 30s presented with quadriplegia and coma 7 h after a 30foot free fall.
Approximately one fifth of ischemic strokes occur in the posterior circulation supplied by vertebrobasilar arteries, where basilar artery occlusion bao tends to. The dense basilar artery sign has specificity as high as 98% for basilar artery thrombosis 2, 3. Patients with basilar artery occlusion were excluded. Recently our study group reported the results of the basilar artery international cooperation study basics, a prospective registry of patients with an acute symptomatic basilar artery occlusion bao. Given lesions will have different effects in different patients. Whether intraarterial treatments improve adult outcomes is controversial. A case of cocaineinduced basilar artery thrombosis nature.
Outcome in patients with basilar artery occlusion treated. Safety and efficacy of intraarterial treatments in children are unknown. A traditional recanalization approach based on historical controls and pathophysiological consideration is local intraarterial thrombolysis iat in eligible patients. Basilar artery occlusion in a teenaged boy treated with intra. This case series reports clinical and functional outcomes and complications of intraarterial treatment thrombolysis or mechanical thrombectomy in patients with basilar artery occlusion. Biemond a thrombosis of the basilar artery and the vascularization of the brain stem. Basilar artery thrombosis may explain as many as 27% of ischemic strokes occurring in the posterior circulation. Basilar artery occlusion usually causes severe disability or death. Background performing mechanical thrombectomy mt in patients with basilar artery occlusion bao is currently not evidencebased. The remaining stroke mechanisms in groups a and b were artery to artery embolism secondary to ba dissection 3 patients, branch artery occlusive disease 3 patients, basilar migraine 2 patients, coagulopathy 1 patient, and unknown 1 patient.
Delayed thrombolysis or endovascular therapy has been performed with some success in patients who present after 3 hours of symptom onset. Successful endovascular therapy for acute basilar thrombosis. Background and purpose the benefits of mechanical thrombectomy mt in basilar artery occlusions bao have not been explored in recent clinical trials. Hyperdense basilar artery an early computed tomography.
The evolution of an arterial thrombus by mri differs from an intraparenchymal hematoma. Among the 12 patients with embolism to the ba, 8 had a cardiac source. Basilar artery occlusive disease in the new england medical. Highresolution magnetic resonance angiography revealed a slitlike fenestration in the basilar artery.
Basilar artery stroke is a rare but very devastating condition comprising around 3% of all ischemic strokes1. We have had a lonstanding interest in the use of intraarterial thrombolytic therapy for vertebrobasilar thrombosis, given the very poor prognosis of most patients and uncertainties about the benefits of intervention. It is a true neurointerventional emergency and, if not treated early, brainstem infarction results in rapid deterioration in the level of consciousness and ultimately death. Acute basilar artery occlusion radiology reference. Basilar thrombosis may be fatal in one patient and compatible with life in another. Stentassisted basilar reconstruction for a traumatic.
Randomized comparison of intraarterial and intravenous thrombolysis in a canine model of acute basilar artery thrombosis. A case of a giant basilar artery aneurysm demonstrating progressive growth and associated neurological deterioration after complete detachable balloon occlusion is reported. Cerebrovascular complications of meningitis have been most extensively documented in the setting of acute bacterial or chronic tuberculous meningitis. The glasgow coma scale gcs score on admission was basilar artery lies at the front of the brainstem in the midline and is formed from the union of the two vertebral arteries. Endovascular revascularization for basilar artery occlusion.
They can cause headtotoe paralysis called lockedin. All blood investigations including thrombophilia workup were normal. Often, complete recovery will follow one or two mild episodes, and no further trouble will occur. To access free multiple choice questions on this topic, click here. Vertebral artery dissection can lead to a complete occlusion of the basilar artery ba, which is a very serious condition, often resulting in death 5,6. A 35yearold woman, apparently normal, who had participated in traditional devithullal a religious dance form involving violent head banging for hours at a time on the evening of the following day developed vomiting, urinary incontinence, altered sensorium and quadriplegia. Intraarterial treatment for basilar artery occlusion jama. Direct puncture of the v3 segment of the vertebral artery. Various reports on basilar artery occlusion and its usual fatal outcome can be found as early as the first part of the 19th century, but in most cases detailed clinical information was lacking and diagnosis was established at necropsy. Cerebral thrombosis 51% unhealthy blood vessels promote formation of a clot thrombosis process of a clot. They can cause headtotoe paralysis called lockedin syndrome. Acute occlusion of the basilar artery is a neurological emergency that has a high risk of severe disability and mortality. Dec 07, 20 basilar artery thrombosis clinical meet 1. Basilar artery occlusion bao accounts for 610% 1 of strokes, causing significant morbidity and mortality often with a poor prognosis.
A patient in his mid40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Dizziness, diplopia, wallenberg syndrome, and even lockedin syndrome are some of the. Top of the basilar syndrome, also known as rostral brainstem infarction, occurs when there is thromboembolic occlusion of the top of the basilar artery. Mechanical thrombectomy for basilar artery occlusion. Acute occlusion of the basilar artery can be due to either thromboembolism, atherosclerosis or propagation of intracranial dissection. Acute basilar artery thrombosis is associated with a poor prognosis.
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