PMC9172617_01
Case 1: (A) Anterior-posterior (AP) digital subtraction angiography (DSA) showing occlusion at the beginning of the right vertebral artery (VA). AP left VA angiogram demonstrating basilar artery occlusion ((B), arrowheads); successful recanalization was obtained by endovascular thrombectomy (C). (D-F) Axial FLAIR magnetic resonance imagining (MRI) showing multiple infarction lesions, involving the right thalamus, corpus callosum, right occipital lobe, right temporal lobe, right cerebellar hemisphere, cerebellar vermis, midbrain and pons.
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F1
Digital subtraction angiography (DSA) demonstrated right vertebral artery (VA) and basilar artery occlusion (Figures 1A,B). Subsequently, the patient underwent mechanical thrombectomy using retrievable stent devices, and the basilar artery was successfully recanalized (TICI grade III, Figure 1C). At postoperative day 5, brain magnetic resonance imaging (MRI) revealed multiple infarcts, involving the right thalamus, corpus callosum, right occipital lobe, right temporal lobe, right cerebellar hemisphere, cerebellar vermis, midbrain and pons (Figures 1D-F).
PMC9172617_02
Case 2: (A-C) Axial brain computed tomography (CT) scan revealing no abnormalities. (D) AP right VA angiogram showing V4 segment occlusion. (E) AP left VA angiogram showing right superior cerebellar artery (SCA) and right posterior cerebral artery (PCA) occlusions; these vessels were successfully recanalized by endovascular thrombectomy (F). (G-I) Axial brain CT at 3 postoperative months showing low-density lesions in the bilateral thalamus, midbrain, right occipital lobe, cerebellar vermis and pons.
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F2
CT of the head (Figures 2A-C) and chest showed no abnormality. DSA revealed the V4 segment of the right VA (Figure 2D), right superior cerebellar artery (SCA) and P1 segment of the right posterior cerebral artery (PCA) were occluded (Figure 2E). The right SCA and right PCA were recanalized after mechanical thrombectomy (TICI grade III, Figure 2F). Brain CT scan at 3 months after the operation showed that low-density lesions in the bilateral thalami, midbrain, right occipital lobe, cerebellar vermis and pons (Figures 2G-I).
PMC9172617_03
Case 3: (A-C) Axial diffusion-weighted imaging (DWI) showing acute cerebral infarction in the bilateral cerebellar hemispheres, cerebellar vermis and periaqueductal gray (arrowheads). (D,E) Magnetic resonance angiography (MRA) and AP left VA angiography demonstrating basilar artery occlusion; successful recanalization was obtained by endovascular thrombectomy (F).
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F3
MRI showed acute cerebral infarction in the bilateral cerebellar hemispheres, cerebellar vermis and periaqueductal gray (PAG) (Figures 3A-C). Magnetic resonance angiography (MRA) revealed basilar artery occlusion (Figure 3D). DSA also confirmed the occlusion of the basilar artery (Figure 3E), which was recanalized after stent embolectomy (TICI grade III, Figure 3F).