title: Bilateral vertebral artery occlusion with retrograde basilary flow in three cases of giant cell arteritis.
abstract: Vertebrobasilar ischaemia is a rare life-threatening complication in giant cell arteritis (GCA). We report three patients with bilateral vertebral artery occlusion. Neurovascular imaging, including CT-angiography, MR-angiography and colour-coded duplex sonography revealed flow reversal in the basilar artery as well as inflammation of the vertebral vessel wall. The first patient died from massive brainstem infarction, the other two patients survived the initial inflammatory phase of GCA. No stroke recurrence at 12 months' follow-up on warfarin and steroid treatment was observed. Bilateral distal vertebral artery occlusion and retrograde basilar artery flow persisted.Outcome in these patients is dependant on potent immunosuppression, concurrent atherosclerotic steno-occlusive disease and presence and/or rapid development of sufficient collateral pathways into the vertebrobasilar circulation. The identification of patients with high risk of ischaemia due to compromised vertebrobasilar flow may be important to select adjunct treatment to immunosuppression, such as anticoagulation in GCA.
authors.affiliation: University of Regensburg, Neurology, Universitaetsstr 84, Regensburg, 93053, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Boettinger
authors.forename: Markus Robert
authors.initials: MR
authors.lastname: Boettinger
authors.forename: Schreglmann
authors.initials: S
authors.lastname: Sebastian
authors.forename: Schreglmann Robert
authors.initials: SR
authors.lastname: Sebastian
authors.forename: Maria-Andreea
authors.initials: MA
authors.lastname: Gamulescu
authors.forename: Maria-Andreea Robert
authors.initials: MA
authors.lastname: Gamulescu
authors.forename: Oliver
authors.initials: O
authors.lastname: Grauer
authors.forename: Markus
authors.initials: M
authors.lastname: Ritzka
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuierer
authors.forename: Gerhard Robert
authors.initials: GR
authors.lastname: Schuierer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bogdahn
authors.forename: Ulrich Robert
authors.initials: UR
authors.lastname: Bogdahn
authors.forename: Andreas
authors.initials: A
authors.lastname: Steinbrecher
authors.forename: Felix
authors.initials: F
authors.lastname: Schlachetzki