TABLE 1:

Summary of Patients with Acute Vertebrobasilar Ischemic Stroke: Presentation, MR Imaging and Angiographic Findings, and Neurointervention

Patient no./Age (y)/Sex	Presenting Symptoms	DWI and/or PWI Findings	DW-PW Mismatch	MRA Findings	Angiographic Findings	Treatment	Pre-TIMI	Post-TIMI
1/50/M	Wallenberg syndrome followed 6 days later by right hemiparesis, slurred speech, and diplopia	Right PICA infarct, new left pontine infarct 6 days later	7.1:22	No right VA or BA flow, possible left VA stenosis	Occluded mid-basilar artery, nearly occluded right VA, pre-occlusive left VA origin	Tristar coronary stent at left VA origin, 14 mg tPA thrombolysis of BA	1	2
2/64/M	Transient diplopia followed by acute onset of slurred speech and transient right leg weakness	Small left pontine lesion, bright on DWI	0.8:131.4	Right VA and mid-basilar stenosis	Severely stenotic non-dominant right VA perfusing the right PICA, pre-occlusive stenosis of left VA origin, BA occlusion	Tristar coronary stent at the left VA origin, 9 mg tPA thrombolysis of basilar at the level of PICA	0	2
3/80/M	Dysarthria, weakness, dizziness; next a.m., inability to move out of bed, vomiting and unresponsive	Acute CVA: right pons, bilateral occipital lobes, rights thalamus	12.1:49.1	Stenosis of left cavernous ICA, occluded left ICA, decreased flow in left PCA	90 95% right ICA stenosis, left ICA occlusion, severe stenosis in mid left SCA and left VA origin, basilar artery apex thrombosis, occluded right VA origin	4 mm × 3.8 cm Guidant Tristar stent in right CCA and 6 mm × 2 cm wall stent in left SCA, 24 mg tPA thrombolysis of BA	0	2
4/60/M	Acute stroke with left hemiparesis followed by coma 3 days later	Right thalamo-capsular and right pons, upper midbrain infarct	PWI not performed	Basilar thrombosis	>90% stenosis, right VA origin; occluded left VA; occlusion of BA at junction of proximal and mid-third; left subclavian steal; 70–80% stenosis, proximal left SCA; >90% stenosis, diffuse and severe atheromatous disease	Tetra coronary stent at right VA origin, 19.5 mg tPA, thrombolysis of BA with minimal dissolution of clot	0	0
5/72/M	Diplopia and ataxia, 36-h duration, followed by coma	Small left pontine lesion	0.4:174.1	Distal basilar artery thrombosis	80% stenosis, right PICA origin; 90%, right AICA; distal BA occlusion; PCA not seen; 40–50% stenosis, distal left CCA	AVE stent, right VA origin; 9 mg tPA and angioplasty of BA	0	1
6/60/M	Headache, diplopia, vertigo, ataxia, acutely lethargic	Bilateral AICA distribution, small pons and midbrain, left occipital and corpus callosum, and left thalamus infarcts	5.6:166.5	No flow in BA	Left VA occlusion, high-grade stenosis with slow flow in right VA, no perfusion of BA	Vertebral origin stent, 9 mg tPA, proximal BA thrombolysis	0	2

Note.—DWI indicates diffusion-weighted imaging; PWI, perfusion-weighted imaging; DW-PW mismatch, diffusion-perfusion mismatch; MRA, MR angiography; TIMI, thrombolysis in myocardial infarction; Pre-TIMI, TIMI grade before treatment; post-TIMI, TIMI grade after treatment; PICA, posterior inferior cerebellar artery; VA, vertebral artery; BA, basilar artery; tPA, tissue plasminogen activator; CVA, cerebrovascular accident; ICA, internal carotid artery; PCA, posterior cerebral artery; SCA, superior cerebellar artery; CCA, common carotid artery; AICA, anterior inferior cerebellar artery.