Complete functional recovery in a child after endovascular treatment of basilar artery occlusion caused by spontaneous dissection: a case report

Stroke caused by dissection of arteries of the vertebrobasilar system in children is still poorly investigated in terms of etiology, means of treatment, course of disease, and prognosis. The aim of this report was to describe the unusual course of a spontaneous dissection of the basilar artery (BA) in a child treated with endovascular techniques and to point out that the plasticity of the brain stem can fully compensate for structural damage caused by stroke. We report the case of a 15-year-old boy who suffered a wake-up stroke with BA occlusion caused by spontaneous dissection. A blood clot was aspirated from the false lumen and the true lumen re-opened, but the patient deteriorated a few hours later, and repeated angiography revealed that the intimal flap was detached, occluding the BA again. The lumen of BA was then reconstructed by a stent. Despite a large pons infarction, the patient was completely recovered 11 months after the onset. The case was analyzed with angiograms and magnetic resonance imaging, macroscopic and microscopic pathological analysis, computed tomographic angiography, magnetic resonance-based angiography, and diffusion tensor imaging. This case illustrates that applied endovascular techniques and intensive care measures can alter the course of potentially fatal brain stem infarction. Our multimodal analysis gives new insight into the anatomical basis for the plasticity mechanism of the brain stem.

Management of a Spontaneous Dissection of the Right External Artery

Introduction: Isolated spontaneous iliac artery dissection is a rare event that is usually linked to connective disorders. There is no established consensus yet on treatment modality. Case report: we report the case of a 44 years old patient with no history of vascular diseases or trauma who was admitted in our institution for a spontaneous dissection of the right external iliac artery. Conclusion: management of spontaneous iliac artery dissection is not well defined. In fact, patients could be safely managed with medical therapy in the absence of signs of complications. Endovascular and open repair are reserved for patients with complications like limb ischemia or imminent artery rupture.