Ischemic Stroke Caused By Vertebrobasilar Artery Dissection: Three Case Reports

Artery dissection in vertebral-basilar artery system is relatively rare, and ischemic stroke induced by arterial dissection of intracranial vertebrobasilar artery are even rarer. VBAD can occur in every age stage, but more common in relatively young people. Clinical presentations are various and non-special. DSA is the most reliable examination tool to diagnose VBAD. We reported three cases of VBAD treated by different methods. The first case was55-year-old.man complaining of right hemiplegia following with dysphonia for15hours. CTA examed one month before admission showed fusiform aneurysm of the basilar artery. MRI and CT showed no infarction but thickening of the basilar artery. DSA demonstrated V4segment of bilateral vertebral artery and proximal basilar artery thickening and double lumen signs with retention of contrast medium around the junction of the vertebral artery and basilar artery. The left vertebral artery was selectively catheterized and300,000Unit of urokinase was injected. Clinical presentations were improved and patient suddenly died because of cardiac and respiratory arrest53hours after the operation. The second case was52-year-old man complaining of repeatedly transient weakness of all four limbs with dysphonia for7days, which deteriorated and accompanied with dysphagia for3days. CTA revealed serious localized stenosis on V4segment of the right vertebral artery and proximal basilar artery, and diffuse stenosis of the left vertebral artery. TCD explored high-resistive polsed doppler waveforms seen on the left vertebral artey, suggested there was intracranial stenotic lesion. The blood signal of the right vertebral artery was accelerated and doppler waveforms was nearly normal. DSA was consistent with CTA. Moreover, DSA showed double lumen in proximal of basilar artery. We implanted Wingspan stent for the junction of right vertebral artery and basilar artery and embolized the left vertebral artery with coils under general anesthesia. No recurrent of artery dissection occurred during19-month follow-up period. The third case was57-year-old man complaining of dizzy and repeatedly transient numbness of right limbs for two weeks. MRA showed the left vertebral artery non-visualization. TCD revealed blood velocity of the right vertebral artery and basilar artery was increased, which suggested mild-to-moderate stenosis. No blood signals of left vertebral artery was not detected by TCD. DSA demonstrated focus serious stenosis on V4segment of left vertebral artery and double lumen from distal of left vertebral artery to the proximal of basilar artery, there were serious localized stenosis on segment of right vertebral artery entering cranial cavity and junction of right vertebrobasilar artery, double lumen of proximal basilar artery and retention of contrast medium. We embolized the left vertebral artery with coil and implanted stents for V4segment of right vertebral artery and proximal of basilar artery under general anesthesia. Patient presented baryglossia, abnormal of coordination examination, nystagmus. Reexamined CT demonstrated left cerebellum infarction. These cases suggest that occlusion of proximal side of the vertebral artery affected by dissection and stenting for the junction between the other side of vertebral artery and the basilar artery may be a feasible method for vertebrobasilar junction artery dissection with or without thrombolysis.