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PubMed1988

The 'herald hemiparesis' of basilar artery occlusion.

In thrombosis of the basilar artery, not infrequently a hemiparesis is present at an early stage, when brain-stem signs may be absent or few, slight or equivocal. It is natural to suspect that such a hemiparesis signifies localization in a cerebral hemisphere, but unexpectedly in a few hours bilateral hemiplegia appears associated with coma or a locked-in syndrome, indicating basilar artery occlusion. I would term this disarming hemiparesis the "herald hemiparesis" of basilar artery occlusion. If the true nature of the condition is recognized early, the use of heparin and other measures may forestall disaster.

Adult↗

PubMed1987

[Subclavian steal: transcranial Doppler sonography of the basilar artery].

In 32 patients with high-grade obstruction of the proximal subclavian artery or of the brachiocephalic trunk and complete or incomplete forms of subclavian steal in the ipsilateral vertebral artery, blood flow in the basilar artery was investigated by transcranial Doppler sonography. With complete steal effect in respect of the vertebral artery, we found, contrary to other investigators, in most cases alterations of the flow in the basilar artery even at rest. These alterations are a systolic deceleration of flow velocity or an alternating flow directed towards the arm in systole and towards the brain in diastole. In about 40% of cases blood flow in the basilar artery could not be assessed, either because the depth of investigation reached was too low, or because--especially in cases with systolic deceleration in one vertebral artery--it was impossible to define the origin of the basilar artery.

Arm↗

PubMed2000

[Double-helical CT pitfall: the native hyperdense basilar artery].

PURPOSE: The unenhanced signs of basilar thrombosis at computed tomography (CT) is the hyperdense visualization of the basilar artery due to intravascular thrombosis. In patients who are clinically asymptomatic, hyperdense visualization of the basilar artery can be observed, if scanned with a double helical CT. Purpose of the present study was to evaluate the diagnostic significance of these changes seen at double-helical CT. MATERIAL AND METHOD: Ten patients patients underwent double-helical CT of a portion of the base of the skull. In each case, 5-mm and 10-mm fused slices were obtained. The patency of the visualized vessels was then documented using contrast-enhanced images. RESULTS: The differences in attenuation between the 5-mm and 10-mm fused slices obtained at native examinations were a median 11 HU. Subsequent contrast enhanced studies documented patency of the examined vessels. CONCLUSION: The present data show that the hyperdense basilar artery as a sign of thrombotic occlusion is not valid when thin, fused slices are obtained at double-helical CT.

Adult↗

PubMed1992

Bilateral anterior cerebral artery territory infarction in the differential diagnosis of basilar artery occlusion.

Two patients with bilateral anterior cerebral artery (ACA) territory infarction are presented whose initial diagnosis was basilar artery occlusion. Both had tetraparesis; in one it was asymmetrical. Both had their eyes open and did not respond to command except that after a delay they followed with their eyes a smoothly moving object; this was the only sign of awareness. One patient had a clear vertical gaze palsy in the upward and downward direction unaccompanied by pupillary abnormalities. Computed tomography revealed fresh bilateral ACA infarction in both patients; occlusion in the hind brain circulation was excluded by angiography in one. Both patients suffered from atrial fibrillation, so cardiac embolism was the most likely cause of the stroke. We conclude that bilateral ACA territory infarction should be considered in the differential diagnosis of basilar artery occlusion, even if accompanied by vertical gaze palsy.

Aged↗

PubMed2004

[Stent-assisted percutaneous transluminal angioplasty for intracranial vertebral and basilar artery stenosis: two case reports].

We report two cases of patients who underwent stent-assisted percutaneous transluminal angioplasty for intracranial vertebral artery (VA) and basilar artery (BA) stenosis. They presented with sudden onset of vertigo and right hemiparesis. Vertebral angiographies revealed severe proximal BA stenosis (case 1) and intracranial VA stenosis (case 2). They underwent angioplasty and stenting, with excellent angiographic results. The availability of new flexible intravascular stents, allowing access to tortuous proximal intracranial vessels, provides a new therapeutic approach for patients with vertebral and basilar artery stenosis.

Aged↗

PubMed2000

Basilar artery occlusion in a child: "clot angioplasty" followed by thrombolysis.

Basilar artery occlusions are rare but have a very poor prognosis. Intra-arterial thrombolysis may produce recanalization and better clinical outcome. A short delay between the onset of symptoms and thrombolysis is considered essential for successful recanalization and for the smallest possible risk of haemorrhagic complications. We present a case of basilar artery occlusion in an 8-year-old child, which was treated by "clot angioplasty" followed by intra-arterial thrombolysis. Thirty hours after progressive alteration of consciousness, speech disturbances and left arm paresis, the child became comatose with decerebrate rigidity. A CT scan showed parenchymal ischaemic lesions. Angiography (performed 36 h after the onset of symptoms) showed a total occlusion of the basilar artery. A clot angioplasty was performed by placing a balloon catheter within the thrombus and inflating it several times in the occluded segment of the basilar artery. Thrombolysis was then performed through the balloon catheter. The basilar artery was only partially recanalized at the end of the procedure, but the perforating arteries of the brain stem had reappeared on angiography. Three months later the child had completely recovered to a normal clinical status. In conclusion, the very poor natural prognosis of basilar artery occlusion requires aggressive management. Recanalization of the basilar artery may be performed even late after the onset of symptoms. Clot angioplasty allows partial recanalization, which may increase the efficiency of thrombolysis.

Acute Disease↗

PubMed2004

Persistent nonfused segments of the basilar artery: longitudinal versus axial nonfusion.

Embryologic development of the basilar artery occurs along two axis systems: longitudinal fusion and axial fusion. Longitudinal fusion consists of midline fusion of paired ventral arteries and reflects the simplified pattern of arterial anatomy found in the spinal cord. Axial fusion consists of fusion of the distal basilar artery, which arises from the caudal division of the internal carotid artery, to the midbasilar agenesis to the posterior inferior cerebellar artery termination of the vertebral arteries. Persistent longitudinal nonfusion (or complete duplication) of the basilar artery is very rare, and persistent axial nonfusion is even rarer. We report one case of persistent longitudinal nonfusion of the basilar artery in a 3-year-old boy and a case of persistent axial nonfusion of the basilar artery in a 43-year-old man.

Adult↗

PubMed1983

The ultrastructural basis of the permeability of arterial endothelium to horseradish peroxidase. Freeze-fracture and tracer studies of rat thoracic aorta and basilar artery.

The thoracic aorta and basilar artery, in which the incidence of atherosclerosis is known to be different, were examined to elucidate the correlation between the structure of the intercellular cleft junction between adjacent endothelial cells and its permeability to HRP. Tannic acid or HRP in the vessel lumen passed through the intercellular clefts of the thoracic aorta into the subendothelial space, whereas in the basilar artery they were unable to penetrate beyond the tight junction of the intercellular clefts. Freeze-fracture replicas revealed that the tight junctions of the thoracic aorta consisted of one to two junctional strands in most areas of the cleaved planes, with discontinuities in some places, whereas those of the basilar artery consisted of a continuous belt-like meshwork of six anastomosing junctional strands on average. These observations confirm that the structure of endothelial junctions in arteries has a close correlation with the permeability of the intercellular clefts to HRP.

Animals↗

PubMed1982

The direct inhibitory action of phentolamine on the contraction of rabbit basilar artery.

The effects of phentolamine on rabbit basilar artery were studied and compared with those on other smooth muscles. The drug showed a dose-dependent depressing effect on high-potassium-induced contracture of rabbit basilar artery. The depressing effect was stronger on tonic than on phasic contraction. When phentolamine was applied during high-potassium-induced tonic contraction, dose-dependent relaxation was observed. The degree of phentolamine-induced-relaxation of high-potassium-induced tonic contraction was not affected by surgical denervation of the basilar artery, although catecholamine content was almost completely lost, as indicated by chemical and histochemical experiments. The relaxed tension caused by phentolamine was reversed by addition of Ca in a dose-dependent manner. Verapamil also showed a dose-dependent relaxing effect on high-potassium-induced contracture, with this relaxed tension being reversed by the addition of Ca in a dose-dependent manner. The relaxing effect of phentolamine on rabbit basilar artery was stronger than on rabbit aorta or guinea-pig taenia coli. Phentolamine depressed serotonin- or histamine-induced contraction at a concentration more than 10 times higher than the concentration for depression of noradrenaline-induced contraction. The depression of high-potassium-induced contracture and reversal by additional Ca, especially in denervated preparations, indicates that phentolamine acts directly on smooth muscle in a similar manner to that of Ca antagonists.

Animals↗

PubMed1999

Angioplasty and stenting of basilar artery stenosis: technical case report.

OBJECTIVE AND IMPORTANCE: Symptomatic basilar artery stenosis has a poor prognosis. Treatment options are limited. Surgical bypasses are technically demanding and of no proven benefit. Percutaneous angioplasty is associated with a significant complication rate, because of intraplaque dissection, restenosis secondary to vessel recoil, and embolic phenomena. A new generation of intravascular stents that are flexible enough to navigate the tortuosities of the vertebral artery may provide a new therapeutic approach. We report a case of basilar artery stenosis that was treated using stent-assisted angioplasty. CLINICAL PRESENTATION: A 56-year-old woman experienced a vertebrobasilar ischemic stroke, from which she recovered. Magnetic resonance angiography revealed severe proximal basilar artery stenosis. Brain Neurolite-single-photon emission computed tomographic scans revealed significantly decreased perfusion of the brainstem. Endovascular intra-arterial pressure measurements revealed a 35-mm Hg gradient across the lesion. INTERVENTION: The patient underwent uncomplicated angioplasty and stenting of the proximal basilar artery, with excellent angiographic results. CONCLUSION: The availability of new flexible intravascular stents, allowing access to tortuous proximal intracranial vessels, provides a new therapeutic approach for patients with basilar artery stenosis. Long-term follow-up monitoring is required to assess the durability of this approach.

Angiography, Digital Subtraction↗

PubMed2003

[A case of basilar artery occlusion of traumatic vertebral artery dissection successfully managed by endovascular treatment].

The author describes a case of basilar artery occlusion caused by vertebral artery dissection with vertebral fracture. A 61-year-old man was admitted with neck pain after a traffic accident. His symptoms suddenly deteriorated and cerebral angiography revealed an occlusion of the right vertebral artery, and complete occlusion of the basilar artery. Local-arterial fibrinolysis with urokinase for basilar artery occlusion and angioplasty with the use of a self-expandable stent for the site of the vertebral artery dissection was performed, and the basilar artery was partially recanalized. The patient's symptoms gradually improved. It should be emphasized that in cases of acute cervical spine injury after major trauma, vertebral artery dissection should be considered. Local-arterial fibrinolysis and angioplasty using a self-expandable stent was regarded as a useful treatment for basilar artery occlusion caused by vertebral artery dissection, in the acute stage.

Arterial Occlusive Diseases↗

PubMed1990

Cholinergic prejunctional inhibition of vasodilator nerve function in bovine basilar arteries.

Helical strips of bovine basilar arteries responded to transmural electrical stimulation with moderate relaxations that were abolished by treatment with tetrodotoxin and oxyhemoglobin and were significantly attenuated by quinidine, as were the relaxations previously seen in dog and monkey cerebral arteries. The relaxant response of the bovine arteries was attenuated by treatment with acetylcholine and physostigmine and was significantly potentiated by atropine. In contrast, relaxations of dog coronary arteries to transmural stimulation, mediated via beta-adrenoceptors, were not influenced by physostigmine and atropine but were attenuated by acetylcholine. Abundant fibers containing cholinesterase were histologically demonstrated in bovine basilar arteries, suggesting the presence of cholinergic innervation. Acetylcholine liberated from the cholinergic nerve appears to act on muscarinic receptors located in vasodilator nerve terminals in bovine cerebral arteries and to interfere with the release of vasodilator transmitters.

Animals↗

PubMed1976

[Partial fenestration of the basilar artery--report of a case (author's transl)].

A 44-year-old male entered the hospital following an episode of subarachnoid hemorrhage on January 28, 1975. The left vertebral angiography revealed an anteriovenous malformation in the mesencephalon mainly feeded by the thalamoperforate artery and the medial branch of the posterior choroidal artery. A partial fenestration of the basilar artery was also demonstrated. The patient refused the surgical treatment for the arteriovenous malformation and was discharged on March, 28, 1975. Fenestration of the basilar artery develops by arrested or abnormal development at the first and second stage of the embryological process. Most basilar artery fenestration demonstrated by brain dissection and angiography are cases of a short segment duplication (partial fenestration) while duplication of the entire segment of the basilar artery (complete fenestration) is quite rare. Only six cases of angiographically revealed basilar artery fenestration have been reported so far in the literature. With increasing application of vertebral angiography, this developmental anomaly may be encountered more frequently.

Basilar Artery↗

PubMed1998

Role of tyrosine kinase in dilator responses of rat basilar artery in vivo.

We tested the hypothesis that dilator responses of the basilar artery to endothelium-dependent vasodilators are mediated by activation of tyrosine kinase in vivo. Using a cranial window in anesthetized rats, we examined responses of the basilar artery to acetylcholine and bradykinin. Topical application of acetylcholine and bradykinin increased diameter of the basilar artery in a concentration-related manner. Genistein, an inhibitor of tyrosine kinase, did not affect baseline diameter of the basilar artery but inhibited vasodilatation in response to acetylcholine and bradykinin, without affecting vasodilatation produced by sodium nitroprusside. Tyrphostin 47, another inhibitor of tyrosine kinase, attenuated acetylcholine-induced dilatation of the basilar artery without affecting vasodilatation in response to sodium nitroprusside. Tyrphostin 63, an inactive analogue of tyrphostin 47, did not affect acetylcholine-induced vasodilatation. Sodium orthovanadate, an inhibitor of tyrosine phosphatase, enhanced acetylcholine-induced dilatation of the basilar artery. These results suggest that dilator responses of the basilar artery to endothelium-dependent agonists, acetylcholine and bradykinin, are mediated in large part by activation of tyrosine kinase. Because vasodilatation produced by these agonists is mediated primarily by nitric oxide, activation of tyrosine kinase may have an important role in nitric oxide production in the basilar artery in vivo.

Acetylcholine↗

PubMed1999

Amyotrophic lateral sclerosis: increased hyaluronic acid in the media of the basilar artery.

Hyaluronic acid in the basilar artery of 10 patients with sporadic amyotrophic lateral sclerosis (ALS) and 7 age-matched control subjects was examined histochemically and densitometrically. The intensity of staining with alcian blue was significantly increased (P=0.0007) in the media in ALS patients compared with that in control subjects. The staining was virtually eliminated by Streptomyces hyaluronidase. These results clearly indicate an increase of hyaluronic acid in the media of the basilar artery in ALS patients.

Aged↗

PubMed1988

An endothelium-dependent contraction induced by A-23187, a Ca++ ionophore in canine basilar artery.

In most isolated canine basilar arteries tested, Ca++ ionophore A-23187 induced a small relaxation followed by a transient contraction. Both contraction and relaxation were abolished by removal of endothelium. The endothelium-dependent contraction induced by A-23187 was attenuated by a phospholipase A2 inhibitor (quinacrine), cyclooxygenase inhibitors (aspirin and indomethacin), a thromboxane A2 (TXA2) synthetase inhibitor (OKY-046) and a TXA2 antagonist (ONO-3708). The A-23187-induced contraction was abolished by lowering the Ca++ concentration of medium to 10%, whereas the contraction induced by 9,11-epithio-11,12-methano-TXA2 (STA2) was attenuated slightly by lowering [Ca++]. The A-23187-induced contraction was reduced markedly by nifedipine (10(-9) to 10(-7) M), but the STA2-induced contraction was only attenuated slightly by nifedipine. Bay K 8644 did not affect the A-23187- and STA2-induced contractions. The present experiments demonstrate that A-23187 induced an endothelium-dependent contraction in canine basilar artery, and suggest that Ca++ might play a key role in production of an endothelium-derived contracting factor (probably TXA2).

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗

PubMed2002

[A case of basilar artery stenosis treated by stent placement].

Symptomatic basilar artery stenosis invariably has poor prognosis owing to limited treatment options. Modernized stent system delivery technology has paved the way for treating tortuous vascular segments of intracranial system. The authors hereby report on the use of intracranial stent to treat basilar artery stenosis. A-61-year old man presented with one month history of recurrent dizziness and dysarthria. He remained symptomatic despite having oral antiplatelets. Magnetic resonance image showed pontine ischemic lesion. Stenosis of proximal portion of basilar artery was detected by magnetic resonance angiography (MRA). Although balloon angioplasty was performed, restenosis was demonstrated by MRA four months later. Stenting was then performed with excellent angiographic results, and there were no procedural complications. The availability of new flexible intravascular stents, allowing access to tortuous proximal intracranial vessels, provides a new therapeutic approach to basilar artery stenosis cases. However long term follow-up is advised to assess the durability of this approach.

Angioplasty, Balloon↗

PubMed2003

Arterial reconstruction by direct surgical clipping of a basilar artery dissecting aneurysm after failed vertebral artery occlusion: technical case report and literature review.

OBJECTIVE AND IMPORTANCE: Dissecting aneurysms of the basilar artery are rare lesions with significant morbidity and mortality. Their management is controversial and often difficult. Although the rebleeding rate is high, clip reconstruction carries prohibitive risk because of the damage to the parent vessel induced by the dissection and the lack of tissue to gather. An enlarging pseudoaneurysm in the chronic phase, however, may have sufficient tissue for clip reconstruction. We present a case in which this strategy was used successfully. CLINICAL PRESENTATION: A 45-year-old woman presented 3 months after an initial presentation with a subarachnoid hemorrhage from a dissecting aneurysm of the basilar trunk at an outside institution. The aneurysm had grown compared with previous angiograms. INTERVENTION: The dominant vertebral artery was sacrificed. Despite this, the aneurysm continued to enlarge. Given the progressive enlargement of the aneurysm, the decision was made to proceed with arterial reconstruction by direct surgical clipping of the saccular component of the dissecting aneurysm. The patient made an excellent recovery with a durable result. CONCLUSION: Although clipping an intracranial pseudoaneurysm in the acute phase may carry a prohibitive risk, clipping such an aneurysm in the chronic phase may occasionally be warranted. To our knowledge, this is the first case reported in the literature in which direct surgical clipping was used as the primary mode of treatment for a basilar artery dissecting aneurysm that enlarged despite occlusion of the dominant vertebral artery. We review the literature on this rare pathological entity and discuss our management strategy.

Aortic Dissection↗