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[CT angiography in basilar artery thrombosis. Initial experiences]
1Abteilung Klinische Neuroradiologie, Universität Heidelberg.
Insights
CT angiography (CTA) is a promising tool for rapidly diagnosing acute basilar artery (BA) occlusion, a condition with high mortality. Early diagnosis with CTA can guide timely thrombolytic therapy decisions.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Acute basilar artery (BA) occlusion carries a high mortality rate (90%) without recanalization.
- Achieving recanalization significantly reduces mortality to 50%.
Purpose of the Study:
- To evaluate the diagnostic utility of CT angiography (CTA) in suspected acute BA occlusion.
- To assess CTA's role in facilitating prompt thrombolytic therapy.
Main Methods:
- Ten patients with suspected BA occlusion underwent conventional CT and spiral CTA.
- CTA covered the basilar artery from the foramen magnum to its tip.
- Digital subtraction angiography (DSA) was used for confirmation in some cases.
Main Results:
- CTA accurately identified BA occlusion in six patients.
- A partially thrombosed megadolichobasilar artery was detected in one patient.
- CTA findings were confirmed by DSA in four cases.
Conclusions:
- CTA shows promise as a rapid diagnostic method for acute BA occlusion.
- This technique may become crucial for guiding therapeutic interventions.
Background And Purpose:
Without recanalisation, acute basilar artery (BA) occlusion has a mortality of 90%, which is reduced to 50% if recanalisation is achieved. Fast diagnosis of BA occlusion is necessary in order to start thrombolytic therapy without delay. We wanted to assess the role of CT angiography (CTA) in the diagnostic evaluation of suspected acute BA occlusion.
Materials And Methods:
Ten patients with clinically suspected BA occlusion were examined with conventional CT and spiral CT angiography. Spiral scanning extended from the foramen magnum to the tip of the basilar artery. For CTA, 130 ml of nonionic contrast media were injected into an antecubital vein. In four patients, transfemoral digital subtraction angiography (DSA) was additionally performed. All but one patient had a follow-up CT examination the next day.
Results:
CTA demonstrated BA occlusion in six patients and a partially thrombosed megadolichobasilar artery in one patient. In four of the six patients with CT angiographically diagnosed BA occlusion, an additional DSA was performed, which confirmed the CTA findings. In three patients the BA showed normal intravasal contrast, and follow-up CT did not show infarctions in the vertebrobasilar territory.
Conclusion:
Although the number of cases is still small, CTA seems to be a promising method for the rapid diagnosis of BA occlusion. It may become a valuable tool for therapy decisions in acute BA occlusions.