Goda Toshiaki, Oyama Naoki, Iwamoto Takanori, Takai Hiroki, Matsubara Shunji, Uno Masaaki, Yagita Yoshiki
Department of Stroke Medicine, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, 577701-0192, Japan.
Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan.
J Med Case Rep. 2021 Mar 9;15(1):119. doi: 10.1186/s13256-021-02675-y.
Isolated basilar artery dissection (IBAD) is a rare but important cause of ischemic stroke. Anti-thrombotic therapy is often used to treat IBAD-related ischemic stroke, but selected cases might need more aggressive treatment. There is no previous report of emergent stenting for IBAD-related ischemic stroke after intravenous thrombolysis.
A 53-year-old Japanese woman was admitted to our hospital with disturbance of consciousness, right hemiplegia, severe dysarthria, and total gaze paralysis. Brain magnetic resonance imaging revealed no ischemic lesion, but magnetic resonance angiography showed stenosis in the basilar artery. After initiation of intravenous thrombolysis, her neurological symptoms dramatically improved. Five hours later, however, her symptoms deteriorated again. Cerebral angiography showed IBAD. Emergent stenting was successfully performed. At 90 days after stroke onset, she had no significant disability, with a modified Rankin scale score of 1.
Emergent stenting can be an effective treatment for patients with IBAD-related ischemic stroke who are resistant to IV-rtPA.
孤立性基底动脉夹层（IBAD）是缺血性卒中的一种罕见但重要的病因。抗栓治疗常用于治疗与IBAD相关的缺血性卒中，但部分病例可能需要更积极的治疗。此前尚无关于静脉溶栓后对与IBAD相关的缺血性卒中进行急诊支架置入术的报道。
一名53岁日本女性因意识障碍、右侧偏瘫、严重构音障碍和完全性凝视麻痹入住我院。脑磁共振成像未显示缺血性病变，但磁共振血管造影显示基底动脉狭窄。静脉溶栓开始后，其神经症状显著改善。然而，5小时后，她的症状再次恶化。脑血管造影显示为IBAD。成功进行了急诊支架置入术。在卒中发作90天后，她无明显残疾，改良Rankin量表评分为1分。
对于对静脉注射重组组织型纤溶酶原激活剂（IV-rtPA）耐药的与IBAD相关的缺血性卒中患者，急诊支架置入术可能是一种有效的治疗方法。
