SHM Converge Scientific Abstract ePoster Gallery-Right Middle Cerebral Peduncle Infarction Due to Basilar Artery Dolichoectasia

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This case report describes a 63-year-old man with recurrent ischemic strokes caused by basilar artery dolichoectasia, a rare condition characterized by abnormal elongation, tortuosity, and dilation of cerebral arteries. Although dolichoectasia most often affects the vertebrobasilar circulation, it can increase the risk of posterior circulation infarcts.<br /><br />The patient presented with acute left-sided numbness and weakness, tinnitus, diplopia, slurred speech, headache, and coordination problems. He had already experienced two prior ischemic strokes within the previous four months, with temporary deficits that had resolved. Imaging showed a markedly enlarged basilar artery measuring about 10 mm, with fusiform ectasia and mild tortuosity. MRI confirmed an acute lacunar infarct in the right middle cerebral peduncle and evidence of mural plaque in the dolichoectatic basilar artery.<br /><br />Because of the large vessel diameter, he was not considered a candidate for stenting. The team discussed possible future compassionate use of flow diversion only if further posterior circulation strokes occurred. Management focused on medical therapy and risk-factor control. Blood pressure was adjusted to a target around 140/90, atorvastatin was continued, and antithrombotic therapy was modified by adding apixaban and stopping aspirin while continuing clopidogrel. He also received physical, occupational, and speech therapy, and was discharged to inpatient rehabilitation with improvement in left-sided function.<br /><br />The report highlights the challenge of treating vertebrobasilar dolichoectasia, for which no proven standard guideline-based treatment exists. It emphasizes the importance of recognizing this rare but serious cause of recurrent stroke and tailoring management to the patient’s anatomy and risk profile.

Asset Subtitle

E’Joven D. Reed

Meta Tag

Author List Ahmed Qadri, Aly Kim, Basit Haider, E’Joven D. Reed, Mohamad Ezzeldin, Ndifreke Ekpa, MD, Uzma Ali

Category Clinical Vignettes

Concept Dolichoectasia

Concept Basilar Artery

Concept Posterior Circulation Infarct

Concept Cerebrovascular Imaging

Concept Computed Tomography Angiography

Distinguished Non-Finalist

Presenter Organization HCA Houston Healthcare/University of Houston

Presenting Author E’Joven D. Reed

Track Adult

Keywords

basilar artery dolichoectasia

recurrent ischemic stroke

vertebrobasilar circulation

posterior circulation infarct

fusiform ectasia

mural plaque

flow diversion

antithrombotic therapy

blood pressure control

inpatient rehabilitation

Dolichoectasia

Basilar Artery

Posterior Circulation Infarct

Cerebrovascular Imaging

Computed Tomography Angiography