• World Neurosurg · Jul 2016

    Case Reports

    Three cases of ruptured basilar artery dissections : from diagnosis to endovascular treatment.

    • Anne-Laure Derelle, Charlotte Barbier, Romain Tonnelet, Liang Liao, René Anxionnat, and Serge Bracard.
    • Department of Interventional and Diagnostic Neuroradiology, CHU Nancy, Nancy, France. Electronic address: al.derelle@chu-nancy.fr.
    • World Neurosurg. 2016 Jul 1; 91: 676.e1-7.

    BackgroundRuptured basilar artery dissections are rare, and prognosis is often disastrous.Case DescriptionWe report 3 recent cases of ruptured dissection from imaging diagnosis to endovascular treatment, presenting 3 different types of dissection and 3 different treatment approaches. These 3 patients presented major subarachnoid hemorrhage (Fisher grade 4): 2 of them were in a coma (World Federation of Neurosurgical Societies Grading System [WFNS] 5), and 1 patient presented with headache only (WFNS 1). Two of the 3 dissections presented a dilated pseudoaneurysm responsible for the bleeding (1 large and 1 small), and the remaining dissection was extensive. The dissection with the larger pseudoaneurysm was treated with coils, resulting in early recanalization requiring another endovascular treatment with coils and a flow diverter stent. The patient with the small pseudoaneurysm was treated with a flow diverter only. These 2 patients had a favorable outcome. The remaining patient with a large tear of the basilar artery had 3 overlapping stents, and fatal rebleeding occurred prematurely.ConclusionsThese 3 cases illustrate different patient management strategies. We discuss this challenging condition and the current position of endovascular therapeutic techniques.Copyright © 2016 Elsevier Inc. All rights reserved.

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