Endovascular Intervention in Basilar Artery Entrapment within the Longitudinal Clivus Fracture: A Case Report

Abstract

Although vascular complications after head trauma is well recognized, basilar artery entrapment within the longitudinal clivus fracture is rare. A 69-year-old man presented with progressive disturbance of consciousness and right hemiplegia after trauma. Computed tomography scan showed a right-sided acute subdural hematoma and multiple skull fractures, including a longitudinal clivus fracture. Magnetic resonance imaging revealed basilar artery occlusion and a small infarction at the ventral part of the pons. On the assumption of acute arterial occlusion caused by thrombus, endovascular thrombectomy was attempted, but resulted in perforation. After the procedure, basilar artery entrapment within the longitudinal clivus fracture turned out to be the cause of the occlusion. The present case suggests that basilar artery entrapment within the longitudinal clivus fracture is a possible cause of neurological deficits after trauma. In this subset, endovascular intervention without a correct diagnosis of this phenomenon is high risk.

Basilar artery incarceration secondary to a longitudinal clivus fracture: A rare and favorable outcome of an often devastating injury

“…However, this resulted in an arterial perforation due to the significant stenosis caused by the clival fracture. [ 6 ]…”

Locked-In Syndrome after Traumatic Basilar Artery Entrapment within a Clivus Fracture: A Case Report and Review of the Literature

“…A PubMed search revealed 18 additional cases of traumatic basilar artery entrapment within a longitudinal clivus fracture worldwide. 6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Interestingly, all of the patients were men. Outcomes in these patients were poor: 8 died, 1 remained in a vegetative state, 3 developed a locked-in syndrome, 5 were left with mild to severe paresis, and only 1 patient recovered completely.…”