PMC9437258_01
Patient 1, MRI on day 1: DWI (a), ADC (b), FLAIR-MRI (c), and
gadolinium-enhanced MR-angiography (d): DWI-hyperintensity, ADC
restriction in the left medulla oblongata, and minimum irregularity in
the diameter of the proximal basilar artery (arrow).
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Gadolinium-enhanced MR-angiography revealed a minimum irregularity in the diameter of the proximal basilar artery (BA) and a reduced diameter of the left vertebral artery (Figure 1).
PMC9437258_02
Patient 2, MRI on admission: time-of-flight MR-angiography (a), DWI (b),
ADC (c), FLAIR (d), and SWI (e) images: basilar artery occlusion, acute
bilateral pontomesencephalic infarctions in DWI/ADC but not in FLAIR
images. Thrombus is visualized in FLAIR sequences as a hyperintense
signal in the basilar artery and as a blooming artifact (arrow) in SWI
images.
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TOF MR-angiography, SWI, and FLAIR images revealed acute bilateral pontomesencephalic DWI hyperintensities/ADC restrictions caused by extensive thrombotic occlusion (Figure 2(a)-(c)) of the BA. Thrombus formation was visualized in DWI and FLAIR sequences as a hyperintense signal in the BA (Figure 2(b) and (d)) and as a blooming artifact (susceptibility vessel sign) in SWI images (Figure 2(e)).
Patient 2: EVT with recanalization of the basilar artery (TICI 3) 6.5 h
after onset of symptoms. Angiography in lateral (a) and
posterior-anterior (b) view.
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Door-to-groin time was 3.5 h; recanalization and reappearance of pontine branches were achieved 6.5 h after onset of symptoms (Figure 3).
Patient 2: time-of-flight MR-angiography: subtotal basilar artery
reocclusion. The vertebral arteries and the top of the basilary are
still visible (in contrast to Figure 2(a)).
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TOF-MR-angiography (MRA) (Figure 4). TCCS revealed a highly reduced and turbulent, but orthograde flow in the BA; a high resistance index in both vertebral arteries (extra- and intracranial); and an elevated flow velocity in the PCA (P1 segment).