Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

Abstract

The diagnosis and treatment of patients with ruptured basilar artery dissection (rBAD) are often difficult. We present a case of rBAD diagnosed with magnetic resonance vessel wall imaging (MR-VWI) and treated with coil embolization with overlapping low-profile visualized intraluminal support (LVIS) stents. The case is of a 49-year-old woman with subarachnoid hemorrhage. digital subtraction angiography (DSA) showed irregularity in an anterior wall of the middle portion of the basilar artery, indicating the presence of a false lumen. MR-VWI showed local enhancement in an arterial wall, which was consistent with the wall irregularity observed in DSA. Overlapping stents (two LVIS stents) was performed in the basilar artery and coils were placed in the false lumen. The false lumen was completely thrombosed, and anterograde blood flow of the basilar artery was preserved. Dual antiplatelet therapy was administered, and the patient underwent an uneventful postoperative course. DSA performed 6 months later showed a white-collar sign. MR-VWI has attracted attention as a useful modality for detecting a ruptured lesion in patients with subarachnoid hemorrhage. This is the first report, to the best of our knowledge, describing the practical use of MR-VWI for rBAD. MR-VWI is suggested to improve diagnostic accuracy for rBAD. There are no established treatments for rBAD; reconstructive endovascular treatments comprising stent placement and coil embolization of a false lumen are promising. The LVIS stent has a braided design and high metal coverage ratio and is considered to be reasonable for use in rBAD. Coil embolization of a false lumen with overlapping LVIS stents may be effective for rBAD.

Basilar artery dissection with rupture 6 years after accidental detection: A case report

“…Surgical clipping and wrapping, endovascular treatment, and conservative treatment have been used for the management of BAD. [ 1 , 5 , 9 , 13 , 15 ] However, currently, there is no established treatment. Since the mortality rate of ruptured BAD is high, we should actively consider proceeding surgery against cases with this distinctive image even in chronic BAD.…”

Superficial temporal artery-superior cerebellar artery bypass and proximal occlusion through anterior petrosal approach for subarachnoid hemorrhage due to basilar artery dissection

“…In recent years, with the advancement of new devices, the number of cases of endovascular treatment for BAD has been increasing. In addition to coils and conventional stents[ 6 , 8 , 9 , 12 , 19 , 22 ], there have been reports of the treatment of ruptured BAD using flow diverters (FDs) recently[ 10 , 21 , 23 ]…”

Evaluating thunderclap headache

“…The sensitivity and specificity of MRA and CTA for detection of cervicocephalic arterial dissection are similar but vary significantly across studies, from 50 to 100% for sensitivity and 29 to 100% for specificity [44], and catheter angiography is the gold standard. In recent years, vessel wall MRI has provided higher resolution of the intimal flap, double lumen and intramural hematoma, improving diagnostic confidence [45 & , [46][47][48]. Some serum markers may aid in the diagnosis, such as the neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio [49] and matrix metalloproteinase 9 level [50].…”