title: Three Cases of Ruptured Basilar Artery Dissection: From Diagnosis to Endovascular Treatment.
abstract: BACKGROUND
  Ruptured basilar artery dissections are rare, and prognosis is often disastrous.
  
  
  METHODS
  We report 3 recent cases of ruptured dissection from imaging diagnosis to endovascular treatment, presenting 3 different types of dissection and 3 different treatment approaches. These 3 patients presented major subarachnoid hemorrhage (Fisher grade 4): 2 of them were in a coma (World Federation of Neurosurgical Societies Grading System [WFNS] 5), and 1 patient presented with headache only (WFNS 1). Two of the 3 dissections presented a dilated pseudoaneurysm responsible for the bleeding (1 large and 1 small), and the remaining dissection was extensive. The dissection with the larger pseudoaneurysm was treated with coils, resulting in early recanalization requiring another endovascular treatment with coils and a flow diverter stent. The patient with the small pseudoaneurysm was treated with a flow diverter only. These 2 patients had a favorable outcome. The remaining patient with a large tear of the basilar artery had 3 overlapping stents, and fatal rebleeding occurred prematurely.
  
  
  CONCLUSIONS
  These 3 cases illustrate different patient management strategies. We discuss this challenging condition and the current position of endovascular therapeutic techniques.
authors.affiliation: Department of Interventional and Diagnostic Neuroradiology, CHU Nancy, Nancy, France. Electronic address: al.derelle@chu-nancy.fr.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Derelle
authors.affiliation: Department of Interventional and Diagnostic Neuroradiology, CHU Nancy, Nancy, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Barbier
authors.affiliation: Department of Interventional and Diagnostic Neuroradiology, CHU Nancy, Nancy, France; Université de Lorraine, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Tonnelet
authors.affiliation: Department of Interventional and Diagnostic Neuroradiology, CHU Nancy, Nancy, France.
authors.forename: Liang
authors.initials: L
authors.lastname: Liao
authors.affiliation: Department of Interventional and Diagnostic Neuroradiology, CHU Nancy, Nancy, France; Université de Lorraine, France; IADI-INSERM U947, France.
authors.forename: René
authors.initials: R
authors.lastname: Anxionnat
authors.affiliation: Department of Interventional and Diagnostic Neuroradiology, CHU Nancy, Nancy, France; Université de Lorraine, France; IADI-INSERM U947, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Bracard
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Basilar dissection; Flow diverter; Stent; Subarachnoid hemorrhage