{
  "abstract": "Background Isolated basilar artery dissection (IBAD) is an uncommon but potentially devastating condition with highly variable clinical presentation, dissection morphology and outcomes. Optimal management remains uncertain, with treatment strategies ranging from medical therapy to reconstructive or deconstructive endovascular approaches. We present a single-centre experience with a comprehensive literature review to evaluate the current evidence for the management of IBAD.Methods We performed a retrospective review of IBAD cases managed at our institution. Clinical presentation, imaging characteristics, treatment approach and outcomes were analysed. Cases were categorised by morphology (stenotic versus dilated) and clinical presentation (ruptured versus unruptured). A literature review was conducted including studies reporting basilar artery dissections with available clinical and angiographic data at presentation. Paediatric, traumatic, iatrogenic and incidental asymptomatic cases were excluded.Results Four patients with IBAD were identified from our institution, demonstrating varying clinical presentations and dissection morphologies. The two unruptured cases showed different vascular morphologies; one dilated dissection treated with a flow-diverting stent and the other stenotic dissection treated with stenting. Both unruptured cases achieved favourable clinical outcomes. Among the two ruptured stenotic dissections, one treated with flow diverting stent had favourable outcome, while the other treated with stenting was complicated by infarction with haemorrhagic transformation and subsequent mortality.Findings from current literature demonstrate heterogeneity in presentation, morphology, management strategies and outcomes in IBAD. Unruptured stenotic dissections presenting with infarct or ischaemia have been reported to be frequently managed conservatively, often with favourable outcomes. In contrast, ruptured IBAD is associated with higher morbidity and mortality and commonly prompts early intervention. Reconstructive endovascular techniques, particularly flow-diverting stents are increasingly utilised in recent year with promising results.Conclusion Isolated basilar artery dissection represents a spectrum of disease in which clinical presentation and lesion morphology are critical in guiding management. Our institutional experience, supported by the literature, suggests that stenotic ischaemic lesions may be managed conservatively or with selective reconstruction. Dilated lesions, particularly when ruptured, may warrant early endovascular treatment. A case-by-case approach remains essential and further studies are required to better define optimal management strategies for IBAD.Disclosures J. Chan: None. J. Ti: None. T. Kee: None.",
  "authors": [
    {
      "affiliations": [
        "Neuroradiology, National Neuroscience Institute, Singapore, Singapore"
      ],
      "name": "J Chan"
    },
    {
      "affiliations": [
        "Neuroradiology, National Neuroscience Institute, Singapore, Singapore"
      ],
      "name": "J Ti"
    },
    {
      "affiliations": [
        "Neuroradiology, National Neuroscience Institute, Singapore, Singapore"
      ],
      "name": "T Kee"
    }
  ],
  "title": "E-220 Isolated basilar artery dissection: case series and a review of current evidence",
  "uid": "82015dc5-7a09-51fa-9b83-72ee9fa50b4d"
}