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Stent alone treatment for dissections and dissecting aneurysms involving the basilar artery.
[locked-in syndrome]
Dissections
and
dissecting
aneurysms
involving
the
basilar
artery
(
BA
)
are
rare
lesions
with
a
poor
prognosis
,
and
controversies
exist
on
treatment
strategy
.
We
describe
the
clinical
presentation
,
radiologic
features
,
and
clinical
outcomes
of
11
consecutive
patients
with
these
lesions
,
treated
using
stent
alone
placement
.
11
patients
were
studied
(
10
men
,
one
woman
)
,
with
a
mean
age
of
51
years
(
range
30
-
68
years
)
.
Clinical
and
angiographic
data
were
reviewed
retrospectively
.
It
was
technically
feasible
to
place
stents
in
all
11
cases
,
and
a
multiple
stents
technique
was
used
in
nine
patients
.
Procedure
related
posterior
circulation
ischemic
complications
occurred
in
two
cases
.
One
patient
presenting
with
locked-
in
syndrome
died
of
a
pulmonary
embolism
3
months
after
treatment
although
the
clinical
condition
was
gradually
improving
after
stent
placement
.
In
the
other
eight
cases
,
improvement
in
initial
symptoms
or
a
stable
condition
was
observed
on
follow-up
at
1
-
48
months
.
Angiographic
follow-up
was
obtained
in
nine
cases
using
DSA
(
n
=
8
)
or
CT
angiography
(
n
=
1
)
.
Successful
occlusion
of
the
aneurysm
or
dissection
sac
was
noted
in
two
cases
,
BA
occlusion
in
one
case
,
disappearance
of
double
lumen
sign
in
one
case
,
and
delayed
retention
of
contrast
medium
in
one
case
.
For
the
remaining
four
patients
there
was
no
change
in
the
configuration
of
the
lesions
on
follow-up
angiographic
results
.
Stent
alone
treatment
as
a
potential
and
disputable
alternative
therapeutic
option
for
the
treatment
of
BA
dissection
and
dissecting
aneurysms
,
although
technically
feasible
,
was
effective
in
only
certain
lesions
,
and
this
treatment
carries
substantial
risks
of
complications
and
a
high
failure
rate
.
The
true
effect
of
this
strategy
is
questionable
.
A
study
involving
larger
populations
and
a
longer
follow-up
is
necessary
to
evaluate
the
efficacy
of
this
treatment
modality
.
Diseases
Validation
Diseases presenting
"poor prognosis"
symptom
adrenal incidentaloma
alexander disease
alpha-thalassemia
carcinoma of the gallbladder
cholangiocarcinoma
cushing syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
hodgkin lymphoma, classical
junctional epidermolysis bullosa
kindler syndrome
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
megacystis-microcolon-intestinal hypoperistalsis syndrome
papillon-lefèvre syndrome
pleomorphic liposarcoma
primary effusion lymphoma
pyomyositis
sneddon syndrome
systemic capillary leak syndrome
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
werner syndrome
wiskott-aldrich syndrome
zellweger syndrome
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