Basilar embolism

In most patients with BA thrombosis, obstruction is limited to the mid portion of the basilar artery (Fig. 1.2) (Voetsch et al. 2004). Embolic occlusion rather than thrombotic occlusion mainly blocks the distal part of the BA when it divides into the PCAs. The distal BA supplies the midbrain and... 

Atheromatous medium-sized arteries at the base of the brain, particularly the vertebral and basilar arteries, may become affected by dolichoectasia. The arteries are widened, tortuous and elongated and may be visualized on MRI or, if the walls are calcified, on CT. Dolichoectasia is usually found in elderly patients with hypertension and diabetes and it may cause stroke through embolization of thrombus or by occlusion of small branch arteries. In younger patients, it should raise the possibility of Fabry s disease. 

Brandt T, Steinke W, Thie A et al. (2000). Posterior cerebral artery territory infarcts clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. Cerebrovascular Diseases 10 170-182 Caplan LR (1980). Top of the basilar syndrome. Neurology 30 72-79 Caplan LR (1993). Brain embolism revisited. 

Fig. 5.34a-c. Patient after SAH with a basilar tip aneurysm seen on CTA in an outside hospital. a Initial DSA did show vasospasm of the PI segment and the superior cerebellar artery on both sides. In addition, some irregularity at the tip of the basilar artery was noted but no real aneurysm, b Repeated DSA 2 months later showed a small basilar tip aneurysm suitable for endovascular treatment, c The patient was scheduled for embolization 10 days later but the aneurysm again was not visible. The patient was referred to surgery... 

To support coil deposition of wide-necked aneurysms a detachable device, the TriSpan (Boston Scientific, Fremont, USA) was designed and approved for clinical use in Europe. The TriSpan can be placed at the base of the aneurysm prior to coil embolization which is delivered through a second microcatheter. The TriSpan acts as a supporting structure and bridges the neck for subsequent coils. However, experience with this new device is limited mainly to broad-based basilar tip aneurysms. Since it is combined with an additional catheter the procedure is somewhat more complex and not really widely used. 

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