PMC10130566_01
(A) Preoperative T2-weighted MRI showed facial nerve compression resulting from VBD (white arrow). (B) Standard frontal view of preoperative DSA also revealed ectasia, elongation, and tortuosity of the vertebrobasilar artery, and the diagnosis of VBD was confirmed. (C) 3D volume rending reconstructed image of preoperative DSA showed severe stenosis of the basilar artery (red arrow). (D) 2D angiography of optimal view of preoperative DSA demonstrated stenosis of the basilar artery, but the degree of stenosis was less severe (red arrow). (E) Postoperative angiography after balloon angioplasty along with stent implantation showed that the stenosis was partly improved (red arrow). (F) 6-month follow-up angiography showed that the stenosis of the basilar was improved (red arrow) while the aneurysm seemed enlarged (blue arrow). (G) Postoperative angiography after stent-assisted coils embolization showed that the aneurysm was occluded (blue arrow). (H) Follow-up angiography after stent-assisted coils embolization showed that an aneurysm-like protrusion of the VBD was occluded (blue arrow). (I) Follow-up MRI indicated facial nerve compression remained (white arrow).
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F1
T2-weighted MRI showed that the aberrant vertebrobasilar artery contributed to facial nerve compression, which corresponded to the clinical symptoms (Figure 1A). Postoperative angiography showed that the stenosis was partly improved (Figures 1B-E). Stent-assisted coil embolization was performed to reduce the bleeding risk (Figures 1F, G). At 15 months after the endovascular treatment, follow-up angiography was performed and showed that an aneurysm-like protrusion of the VBD was occluded, but MRI indicated that facial nerve compression remained (Figures 1H, I).
(A) Gross specimens of the vertebrobasilar system showed ectasia, elongation, and tortuosity of the vertebrobasilar artery accompanied by brain stem compression caused by VBD. (B) Schematic diagram of tissue slice position: the proximal region (E), distal region (F), and apparent dilatated region (C). (C) Light microscopy images from H-E staining (20 x) of tissue slice of the apparent dilatated region: irregular intravascular lumen, loss of smooth muscle, and multiple thromboses among the dissection. (D) Locally magnified images (40 x) focusing on the intravascular lumen of the section of the apparent dilatated region showed that the stent was suspended, and there was no vascular endothelium coverage on the surface (blue arrow). (E) Light microscopy images from H-E staining (40 x) of tissue slice of the proximal region: the stent was relatively adherent, and vascular endothelium or connective tissue coverage appeared above the stent (red arrow). (F) Light microscopy images from H-E staining (40 x) of tissue slice of the distal region: smooth muscle coverage could be observed above the stent (black arrow).
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F2
Brain stem compression caused by VBD could also be observed (Figure 2A). Three specified regions of VBD, the proximal region, the distal region, and the apparent dilatated region were cut into sections, and microscopic observation was performed (Figure 2B). The section of the apparent dilatated region showed that the stent was suspended, and there was no vascular endothelium coverage on the surface (Figures 2C, D), which was evident and likely contributed to the in-stent thrombosis after the discontinuation of antiplatelet therapy. For the proximal region, the stent was relatively adherent, and vascular endothelium or connective tissue coverage appeared above the stent (Figure 2E). For the distal region, even, smooth muscle coverage could be observed on the surface of the stent (Figure 2F).