Basilar Artery Bifurcation Aneurysm: Spontaneous SAH and Recurrent Aneurysm Rupture During Computed Tomography Angiography

Background: Basilar artery occlusion (BAO) is associated with high risk of disability and mortality. This study aimed to assess the prognostic value of a new radiological score: the “Basilar Artery on Computed Tomography Angiography score (BATMANs)”. Methods: A retrospective analysis of consecutive stroke patients with a diagnosis of BAO on CT angiography (CTA) was performed. BATMANs is a 10 point CTA-based grading system. We allocated 1 point for each patent segment (proximal, middle and distal) of the basilar artery, 1 point for any patent intracranial vertebral arteries (VA), 1 point for each posterior cerebral artery (PCA) and 2 points for each posterior communicating artery (PcoM) or 1 point for hypoplastic PcoM (<1 mm diameter). Two investigators reviewed the CTA images blinded to clinical outcome. Reliability was assessed with intraclass coefficient correlation (ICC). Good outcome was defined as modified Rankin Scale≤3 at 3 months; successful reperfusion as thrombolysis in cerebral infarction 2b-3. BATMANs was externally validated and compared with the Posterior Circulation Collateral score (PC-CS). Results: The derivation cohort (DC) included 83 patients with 41 in the validation cohort (VC). In receiver-operating-characteristic (ROC) analysis, BATMANs had an area-under-curve (AUC) of 0.81 (95%CI 0.7-0.9) in DC and an AUC of 0.74 (95%CI 0.6-0.9) in VC. BATMANs<7 was the optimal threshold for poor outcome in DC (sensitivity=84%, specificity=76%). In logistic regression adjusted for age and clinical severity, BATMANs<7 was associated with poor outcome in DC (OR 5.5, 95% CI 1.4 -21; p=0.01), in VC (OR 6.9, 95% CI 1.4-33; p=0.01) and among endovascular patients (OR 3.8, 95%CI 1.0-14; p=0.05). BATMANs was independently associated with functional outcome after adjustment for revascularization and time to treatment (OR 4.8, 95%CI 1-18; p=0.01); however, it was not associated with recanalization. Inter-rater agreement was excellent (ICC 0.85, 95% CI 0.76-0.89). BATMANs showed higher accuracy in comparison with PC-CS (p=0.03). Conclusions: The addition of collateral quality to clot burden in BATMANs appears to improve prognostic accuracy in BAO patients.

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Rupture of anterior communicating artery aneurysms during computed tomography angiography: description of the pathway for intraseptal and intraventricular hemorrhage

Journal of Neurosurgery ◽

10.3171/2011.4.jns101629 ◽

2011 ◽

Vol 115 (3) ◽

pp. 617-620 ◽

Cited By ~ 6

Author(s):

Felix Scholtes ◽

Francesco Signorelli ◽

Michel W. Bojanowski

Keyword(s):

Computed Tomography ◽

Contrast Medium ◽

Computed Tomography Angiography ◽

Intraventricular Hemorrhage ◽

Aneurysm Rupture ◽

Septum Pellucidum ◽

Ventricular System ◽

Anterior Communicating Artery ◽

Lamina Terminalis ◽

Interhemispheric Fissure

Intraventricular hemorrhage is common after the rupture of anterior communicating artery (ACoA) aneurysms, although the anatomical pathway has not been described. Knowledge of the mechanism of hemorrhage may enhance understanding of its prognosis. Using CT angiography, the authors analyzed this pathway in 2 cases of ACoA aneurysm rupture associated with intraventricular hemorrhage. The initial hemorrhages created a hyperdense ventriculographic image on which the subsequent contrast medium ejection could be followed. The contrast medium entered the subarachnoid space of the anterior interhemispheric fissure and broke through the lamina rostralis into the septum pellucidum and into the frontal horns of the lateral ventricles. Thus, the authors provide an explanation for bleeding from ACoA aneurysms into the ventricular system in the presence of an intact lamina terminalis. The septum pellucidum may act as a buffer before extension of the bleeding into the ventricular system.

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Four-Dimensional Computed Tomography Angiography Demonstrating a Ruptured Basilar Artery Aneurysm Causing Anterior Cerebral Circulation Arrest

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2016.05.016 ◽

2016 ◽

Vol 25 (9) ◽

pp. e146-e147 ◽

Cited By ~ 1

Author(s):

Hans G.J. Kortman ◽

Hieronymus D. Boogaarts ◽

Mathias Prokop ◽

Frederick J.A. Meijer

Keyword(s):

Computed Tomography ◽

Basilar Artery ◽

Computed Tomography Angiography ◽

Cerebral Circulation ◽

Artery Aneurysm ◽

Basilar Artery Aneurysm

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Anatomical Variations and Dimension of the Intracranial Vertebral Artery: Evaluation With Multidetector Computed Tomography Angiography

10.21203/rs.3.rs-325782/v1 ◽

2021 ◽

Author(s):

Bukola Omotoso ◽

Rohen Harrichandparsad ◽

Kapil Satyapal ◽

Indheresan Moodley ◽

Lelika Lazarus

Keyword(s):

Computed Tomography ◽

Vertebral Artery ◽

Multidetector Computed Tomography ◽

South African ◽

Basilar Artery ◽

Computed Tomography Angiography ◽

Anatomical Variation ◽

Posterior Inferior Cerebellar Artery ◽

Anatomical Variations ◽

Multidetector Computed Tomography Angiography

Abstract The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and White) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Imaging of the entire course of the VA from the origin to the point of convergence to form the basilar artery may be necessary to decide a treatment strategy for interventions in the vicinity of the VA.

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