Successful endovascular recanalization of a partially occluded basilar artery fenestration.

Meinel, Thomas Raphael; Pult, Frauke; Gralla, Jan; Arnold, Marcel; Bassetti, Claudio; Jung, Simon (2019). Successful endovascular recanalization of a partially occluded basilar artery fenestration. Interventional neuroradiology, 25(1), pp. 44-46. Sage Publications 10.1177/1591019918793340

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A 76-year-old man with a history of arterial hypertension, obstructive sleep apnea, dyslipidemia, family history of cardiovascular events, prestroke and overweight presented 90 minutes after acute onset of right-sided sensorimotor hemiparesis, hemiataxia and dysarthria (National Institutes of Health Stroke Scale (NIHSS) 9/42). Magnetic resonance imaging (MRI) revealed a pontine ischemia and MR angiography showed a thrombus in the middle to distal portion of the basilar artery. Owing to the location, an occlusion of one lumen of a fenestrated basilar artery was suspected. Fearing the risk of peripheral dislocation, intravenous thrombolysis was withheld after an interdisciplinary discussion and direct endovascular thrombectomy (Solitaire stent retriever) was successfully performed by passing the stent retriever specifically through the affected lumen and between the thrombus and the vascular wall, which would normally be avoided. Angiography after complete reperfusion (Thrombolysis in Cerebral Infarction grade 3) confirmed a fenestration in the middle to distal portion of the basilar artery where the thrombus was initially located (blue and green arrow). Follow-up MRI after 24 hours showed only minimal ischemic damage in the left pontine area, and the patient was discharged home with ambulatory physiotherapy for residual minimal gait disturbance (NIHSS 0).

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Meinel, Thomas Raphael; Pult, Frauke; Gralla, Jan; Arnold, Marcel; Bassetti, Claudio and Jung, Simon

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1591-0199

Publisher:

Sage Publications

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

14 Aug 2018 14:25

Last Modified:

24 Feb 2019 01:31

Publisher DOI:

10.1177/1591019918793340

PubMed ID:

30092730

Uncontrolled Keywords:

Basilar artery endovascular fenestration ischemic stroke thrombectomy

URI:

https://boris.unibe.ch/id/eprint/119272

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