Persistent otic artery.

Ischaemic strokes and TIA are increasingly being found to be due to arterial cervical dissection, particularly in young adults. Physicians have better knowledge of this disease, and diagnostic neuroimagery has improved. Sometimes traumatic, arterial dissection can also be truly spontaneous or coincides with ordinary neck movement. Dissection consists in an intramural hematoma, and affects most commonly the carotid artery. In 25% of cases, two or more cervical arteries appear to be affected simultaneously, suggesting fibromuscular dysplasia. Pathophysiological considerations remain unclear and several hypotheses are considered. Clinical manifestations are evocative and cervical warning signs such as pain, headache or Horner's syndrom provide an opportunity to recognize the patients few hours or days before cerebral or ocular ischemia occurs. Conventional angiography remains the gold standard in the diagnosis of arterial dissections but ultrasonography and magnetic resonance techniques are more and more often informative. Although no therapeutical trial is available, anticoagulant therapy has been recommended, except in intracranial dissection. Recurrent dissections are very rare and long term functional prognosis seems to be favourable.

Basilar Artery↗

PubMed2004

Coil treatment of a fusiform upper basilar trunk aneurysm with a combination of "kissing" neuroform stents, TriSpan-, 3D- and fibered coils, and permanent implantation of the microguidewires.

Endovascular coil occlusion of fusiform intracranial aneurysms without sacrifice of the parent artery can be technically challenging. Bridging of wide aneurysm necks with stents is common practice for side-wall aneurysms but is less frequently used for bifurcation aneurysms. We describe the technical aspects of the successful coil occlusion of a fusiform aneurysm of the upper basilar trunk, with preservation of the parent vessel. The procedure comprised the following steps: (a) stenting of the left V1- and proximal V2 segments; (b) simultaneous deployment of two Neuroform stents from both P1 segments down to the basilar artery ("kissing" stents) (c) using a TriSpan device to hold (d) three-dimensional electrolytically detachable coils in place and (e) filling the aneurysmal lumen mainly with fibered electrolytically detachable coils; and finally (f) cutting the extracorporeal part of both microguidewires below the skin level in both groins, leaving the microguidewires as they were used for the deployment of the stents in place, thus reaching from both P2 segments down to the basilar artery and further proximally.

Basilar Artery↗