PMC6232774_01
Spontaneous basilar artery (BA) dissection causing acute ischemic stroke. Non-contrast CT (A). Anterior (B), and lateral (C) projection of angiography before stent deployment. There is a "non-occlusive thrombus" in the mid-BA with regular residual lumen (C). Intracranial atherosclerotic stenosis was then suspected (black arrow). The super -selective angiography control was performed to confirm the tip of the microcatheter in the real lumen (D). Angiography after the first mechanical thrombectomy maneuver (E). No clot was found. Angiography immediately after stent detachment showed the stent restored the BA caliber (F). The distal marker of the stent lined up with the BA tip whereas the proximal marker was located within the right vertebral artery. MRI in transverse DWI section showed acute infarctions in right pons (G) and occipital lobe (H) after procedure.
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F1
Post-operative Diffusion-weighted imaging (DWI) showed acute infarctions in the right pons and occipital lobe (Figure 1).
Proximal in-stent restenosis on 18-months follow-up angiography. Anterior (A,B) and lateral (C,D) view of subtracted (A,C) and un-subtracted angiography (B,D) in right VA demonstrated proximal stenosis within the tapered length of the stent construct. Oblique view of the angiography (E). Black and white arrow indicated proximal and distal markers of the stent, respectively.
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F2
The restenosis was located within the proximal tapered area of the SOLITAIRE stent (Figure 2).
oblique view from an un-subtracted angiography of the right vertebral artery shows right VA dissection extending to BA. The markers of the SOLITAIRE stent and the Dragonfly Duo OCT imaging catheter are noted in the left panel. White dashed ellipses on the left panel correspond to the cross-sections of the OCT acquisition (right). The Dragonfly Duo imaging catheter is illustrated in the middle. (A), the OCT image demonstrated a severe dissection (*), between the intima (single white arrow) and media (double white arrow). Poor strut-wall apposition was noted (struts indicated by the white arrowheads). (B), 10 mm proximal to the cross-section A, there was a mural hematoma (single white arrow) within the dissection. The intima was complete without disruption. The false lumen (*) between the intima and media (double white arrow) caused the moderate stenosis of the BA. (C), at the level of restenosis in right VA within the tapered area of the SOLITAIRE stent, there is a disrupted transverse flap (single white arrow) and mural hematoma, suggesting the dissection originated in right VA and extended distally to BA. (D), at the level of posterior inferior cerebral artery (PICA) origin, no dissection is visible on DSA or OCT. Single white arrow indicated PICA. The presence of remnant transverse flap, double lumen and mural hematoma were signs of intracranial BA dissection on OCT.
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F3
OCT data were analyzed by the ILUMIEN OPTIS Imaging System. OCT imaging demonstrated visualization of a dissection and poor stent strut wall apposition (Figure 3).