PMC8488096_01
DSA images of all four basilar artery occlusions pre- (A1,B1,C1,D1) and post-interventionally (A2,B2,C2,D2). Arrows display arterial occlusions and/or thrombi, arrowheads display the dysplastic right vertebral artery.
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F1
IVT and MT achieved complete recanalization (Figures 1A1,A2) and an excellent neurological outcome with a modified Rankin Scale (mRS) of 0 and a National Institutes of Health Stroke Scale (NIHSS) of 0. Again, full recanalization was achieved and the patient remarkably improved (mRS 0/NIHSS 0) (Figures 1B1,B2). CTA confirmed the third recurrent BAO, and the patient was again successfully recanalized with MT (Figures 1C1,C2). MRA again showed a thrombus in the distal basilar artery and the proximal left posterior cerebral artery, which were removed by endovascular therapy using an aspiration catheter (Figures 1D1,D2).
Pre- and post-interventional images of the right dysplastic vertebral artery and its multifocal stenoses. (A) MRA displaying the right vertebral artery with multiple intra- and extracranial irregularities (tailed arrows) corresponding to the diagnosis of a dysplastic vertebral artery. (B) Pre-interventional digital subtraction angiography of the posterior circulation with irregularities (tailed arrows) and distal stenosis of the vertebral artery (arrow head) proximal to the outflow of the right posterior inferior cerebellar artery in two plains. (C) Post-interventional digital subtraction angiography of the posterior circulation after coil occlusion of the right V4 segment (tailed arrow) with preservation of the right posterior inferior cerebellar artery outflow.
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F2
The proximal V4-segment was occluded in a cross-over technique with multiple platinum coils, whereas the right PICA and the distal V4-segment were preserved (Figures 2A-C).
Timeline of stroke events.
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F3
Figure 3 depicts a full timeline of the mentioned events.