[Diagnostic angiography using multi-slice spiral CT in acute obstruction of the basilar artery].
OBJECTIVE
To evaluate the diagnostic efficiency of CT angiography in case of clinical signs of acute brainstem infarction for the therapeutic management of catheter-based local thrombolysis.


METHODS
3 patients (2 males, 1 female) suffering from an acute onset of brainstem symptoms and being suspicious of an occluded basilar artery were included into this report. 1 patient underwent selective vertebral arteriography. 2 patients were initially examined with CT angiography using a 4-row scanner and 100 ml intravenous contrast agent.


RESULTS
In one patient, an occlusion of the basilar artery was excluded with catheter-based angiography. Subsequently, the patient was treated with systemic thrombolysis using r-tPA because of a thalamus infarction seen in MRI. 2 patients who have been initially examined with CT angiography presented with complete occlusions of the basilar arteries. These patients underwent r-tPA thrombolysis by means of superselective micro-catheter approaches of the vertebrobasilar vessels. CT angiography was very useful for determinating the occlusion length of the basilar artery pre-therapeutically, and in 1 case for ruling out an occluded vertrebral artery for catheterization. All patients recovered well under thrombolytic therapy applied systemically or selectively.


CONCLUSIONS
Cerebral multi-slice CT angiography is a fast and save technique for detecting or ruling out an acute basilar artery occlusion. Thus, in cases of equivocal clinical signs CT angiography is recommended before the decision of thrombolytic therapy is made.
Schmitt
R
R
Institut für Diagnostische und Interventionelle Radiologie, Herz- und Gefassklinik GmbH Bad Neustadt an der Saale. schmitt.radiologie@herzchirurgie.de
Christopoulos
G
G
Salveter
E
E
Ziegler
V
V
Brunner
H
H
Wedell
E
E
Griewing
B
B
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000187:drug effects; D020526:Brain Stem Infarctions / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007261:Infusions, Intra-Arterial; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D036542:Tomography, Spiral Computed; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000188:drug therapy
D010959:Tissue Plasminogen Activator