title: Endovascular Treatment of Basilar Artery Thrombosis Secondary to Bilateral Vertebral Artery Dissection with Symptom Onset Following Cervical Spine Manipulation Therapy.
abstract: BACKGROUND
  Vertebral artery (VA) dissection (VAD) has been described following neck injury and can be associated with stroke, but the causal association with cervical spine manipulation therapy (cSMT) is controversial. The standard treatment for VAD is antithrombotic medical therapy. To highlight the considerations of an endovascular approach to VAD, we present a critical case of bilateral VAD causing embolic occlusion of the basilar artery (BA) in a patient with symptom debut following cSMT.
  
  
  METHODS
  A 37-year-old woman presented with acute onset of neurological symptoms immediately following cSMT in a chiropractic facility. Acute magnetic resonance imaging (MRI) showed ischemic lesions in the right cerebellar hemisphere and occlusion of the cranial part of the BA. Angiography depicted bilateral VAD. Symptoms remitted after endovascular therapy, which included dilatation of the left VA and extraction of thrombus from the BA. After 6 months, the patient had minor sensory and cognitive deficits.
  
  
  CONCLUSIONS
  In severe cases, VAD may be complicated by BA thrombosis, and this case highlights the importance of a fast diagnostic approach and advanced intravascular procedure to obtain good long-term neurological outcome. Furthermore, this case underlines the need to suspect VAD in patients presenting with neurological symptoms following cSMT.
authors.affiliation: Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Ronni
authors.initials: R
authors.lastname: Mikkelsen
authors.affiliation: Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Rikke Beese
authors.initials: RB
authors.lastname: Dalby
authors.affiliation: Danish Stroke Center, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Hjort
authors.affiliation: Danish Stroke Center, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Claus Ziegler
authors.initials: CZ
authors.lastname: Simonsen
authors.affiliation: Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Sanja
authors.initials: S
authors.lastname: Karabegovic
mesh_terms: D000328:Adult; D001488:Basilar Artery; D002533:Cerebral Angiography; D002574:Cervical Vertebrae; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D026201:Musculoskeletal Manipulations / Q000009:adverse effects*; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery