Recovery of injured corticospinal tracts after late recanalisation of basilar artery occlusion

In this study, we performed emergency stent angioplasty in a patient with basilar artery occlusion (BAO) at 21 hours after onset. Serial diffusion tensor tract imaging revealed that the ischaemic corticospinal tracts (CSTs), which passed through pontine infarct, rapidly recovered to normal level even after delayed reperfusion. This case provided in vivo evidences that ischaemic white matter was still salvageable even after prolonged ischaemia. It also provided a new method (diffusion tensor tract imaging) and a novel therapeutic target (white matter) in the evaluation and treatment of acute BAO. A 35-year-old man suffered acute onset of dizziness, generalised weakness and mental dullness for 21 hours. Neurological examination revealed consciousness disturbance, drooping eyelids, horizontal gaze-evoked nystagmus, facial weakness, dysarthria, dysphagia, bilateral limb weakness (Medical Research Council grade III) and a NIHSS score of 19. Diffusion weighted imaging after admission revealed acute ischaemic lesions in right dorsolateral medulla, left cerebellum and bilateral pontine base (figure 1A–C). No intracranial haemorrhage was detected (figure 1D–F). On MR angiography, left vertebral artery (VA) and basilar artery (BA) were not patent while right VA was faintly visible (data not shown). Diagnostic cerebral angiography was performed after obtaining informed consent from the next of kin. After intravenous sedation and general anaesthesia, a sheath passage of size 6 Fr was applied by Seldinger technique. Angiography of the aortic arch was performed by a 5F pigtail catheter (Cordis, Miami, Florida, USA). Angiography of left internal carotid artery (ICA) and left VA were performed by a 5F VER catheter (Cordis, Miami, Florida, USA). Complete occlusion of BA beyond the anterior inferior cerebellar artery branch was demonstrated (figure 2A). Posterior cerebral artery (PCA) and superior cerebellar artery were …