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Stent-assisted basilar reconstruction for a traumatic vertebral dissection with a large basilar artery thrombosis
  1. Erik F Hauck1,2,
  2. Sabareesh K Natarajan1,2,
  3. Dennis B Horvathy1,2,
  4. L Nelson Hopkins1,2,3,
  5. Adnan H Siddiqui1,2,3,
  6. Elad I Levy1,2,3
  1. 1Department of Neurosurgery, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  2. 2Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York, USA
  3. 3Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  1. Correspondence to Elad I. Levy, University at Buffalo Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, 3 Gates Circle, Buffalo, NY 14209, USA; elevy{at}ubns.com

Abstract

An individual in their 30s presented with quadriplegia and coma 7 h after a 30-foot free-fall. Angiography confirmed left vertebral artery dissection causing vertebral artery occlusion (thrombolysis in myocardial infarction (TIMI) 0) and basilar artery thrombosis. Deployment of six self-expanding intracranial stents (right P1 to left V3) resulted in recanalization (TIMI 3). Postoperative MRI demonstrated a large brainstem infarction; the patient was ‘locked-in’. In the following 6 months, the patient recovered to ambulation and independence. Aggressive recanalization for symptomatic vertebrobasilar dissection/occlusion may be considered. Despite major diffusion-weighted imaging brainstem lesions, recovery is possible.

  • Acute ischemic stroke
  • artery
  • brain
  • dissection
  • endovascular therapy
  • intervention
  • intracranial stent
  • stent
  • stroke

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Footnotes

  • Off label devices: Stents for acute stroke treatment.

  • Competing interests Dr Hopkins receives research study grants from Abbott (ACT 1 Choice), Boston Scientific (CABANA), Cordis (SAPPHIRE WW) and ev3/Covidien Vascular Therapies (CREATE) and a research grant from Toshiba (for the Toshiba Stroke Research Center); has an ownership/financial interest in AccessClosure, Boston Scientific, Micrus and Valor Medical; receives royalties from Cordis (for the AngioGuard device); serves on the Abbott Vascular Speakers' Bureau; receives honoraria from Bard, Boston Scientific, Cordis, and from the following for speaking at conferences—Complete Conference Management, Cleveland Clinic and SCAI; serves as a consultant to or on the advisory board of Abbott, AccessClosure, Bard, Boston Scientific, Cordis, Gore, Lumen Biomedical, Micrus and Toshiba; and serves as the conference director for Nurcon Conferences/Strategic Medical Seminars LLC. Dr Levy receives research grant support (principal investigator: Stent-Assisted Recanalization in acute Ischemic Stroke, SARIS), other research support (devices) and honoraria from Boston Scientific, and research support from Micrus Endovascular and ev3/Covidien Vascular Therapies; has ownership interests in Intratech Medical Ltd and Mynx/Access Closure; serves as a consultant on the board of Scientific Advisors to Codman & Shurtleff, Inc.; serves as a consultant per project and/or per hour for Micrus Endovascular, ev3/Covidien Vascular Therapies and TheraSyn Sensors, Inc.; and receives fees for carotid stent training from Abbott Vascular and ev3/Covidien Vascular Therapies. Dr Levy receives no consulting salary arrangements. All consulting is per project and/or per hour. Dr Siddiqui has received research grants from the University at Buffalo and from the National Institutes of Health (NINDS 1R01NS064592-01A1, Hemodynamic induction of pathologic remodeling leading to intracranial aneurysms); is a consultant to Codman % Shurtleff, Inc., Concentric Medical, ev3/Covidien Vascular Therapies and Micrus Endovascular; serves on speakers' bureaus for Codman & Shurtleff, Inc. and Genentech; and has received honoraria from Genentech, Neocure Group LLC, an American Association of Neurological Surgeons' course and an Emergency Medicine Conference, and from Codman & Shurtleff, Inc. for training other neurointerventionists. Dr Siddiqui receives no consulting salary arrangements. All consulting is per project and/or per hour. Dr Hauck, Dr Horvathy and Dr Natarajan have no potential conflicts of interest to report.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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