Basilar artery thrombosis: imaging and endovascular therapy

• Published in: Radiologia medica Vol. 115; no. 8; pp. 1219 - 1233
• Main Authors: Bonatti, G., Ferro, F., Haglmüller, T., Pernter, P., Naibo, L.
• Format: Journal Article
• Language: English; Italian
• Published: Milan Springer Milan 01.12.2010
• Subjects: Angioplasty - methods; Basilar Artery; Cerebral Angiography - methods; Contrast Media; Diagnostic Radiology; Female; Humans; Imaging; Interventional Radiology; Intracranial Thrombosis - diagnostic imaging; Intracranial Thrombosis - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Radiologia Vascolare ed Interventistica; Radiology; Retrospective Studies; Thrombolytic Therapy - methods; Tomography, X-Ray Computed - methods; Treatment Outcome; Ultrasound; Vascular and Interventional Radiology; Rimozione meccanica del trombo; CT angiography (CTA); Mechanical clot removal; Trombolisi intra-arteriosa; Angio-TC; Basilar artery thrombosis; Trombosi dell’arteria basilare; Intra-arterial lysis
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-010-0568-2

Purpose Basilar artery thrombosis represents a rare type of ischaemic stroke with a mortality rate of 80%–90% if not promptly treated. The aim of our study was to review our experience with computed tomography angiography (CTA) in the diagnosis of basilar artery thrombosis and its treatment with endovascular procedures. Materials and methods Our retrospective study is based upon 59 nontrauma patients with episodes of sudden loss of consciousness. Patients were investigated using unenhanced brain CT followed by intracranial CTA (16-slice CT) when no parenchymal haemorrhage was detected. Patients with a CTA diagnosis of basilar artery thrombosis were considered for endovascular treatment. CTA accuracy was evaluated by considering the 12 patients who underwent endovascular angiography (the gold standard). The success of endovascular therapy was evaluated by considering the degree of microcirculatory reperfusion. Results After the exclusion of 33 patients affected by parenchymal or subarachnoid haemorrhage, the final study consisted of 26 patients who underwent CTA. Basilar artery thrombosis was diagnosed in 15 of them, and 12 were treated at our institution. The comparison between CTA and endovascular angiography showed 100% agreement in evaluating occlusion site and extension. Seven patients underwent intra-arterial lysis, and five underwent mechanical clot removal. Conclusions CTA, with its wide availability and rapid execution times, is the most indicated examination in the case of suspected basilar artery thrombosis. Although there is a lack of randomised controlled prospective studies suggesting the most appropriate therapeutic approach to basilar artery thrombosis, our study lends weight to the role of interventional neuroradiology in the treatment of this condition.