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Case Reports
. 2021 Sep 6:12:445.
doi: 10.25259/SNI_384_2021. eCollection 2021.

Fatal recurrent ischemic stroke caused by vertebral artery stump syndrome

Akinari Yamano  1 , Yasunobu Nakai  2 , Kazuki Akutagawa  1 , Haruki Igarashi  2 , Kazuaki Tsukada  1 , Toshitsugu Terakado  1 , Kazuya Uemura  2 , Eiichi Ishikawa  1
Affiliations
Case Reports

Fatal recurrent ischemic stroke caused by vertebral artery stump syndrome

Akinari Yamano et al. Surg Neurol Int. .

Abstract

Background: Vertebral artery stump syndrome (VASS) develops into recurrent posterior circulation ischemic stroke after ipsilateral vertebral artery (VA) occlusion at its origin.

Case description: The patient was a 46-year-old man with the right posterior cerebral artery occlusion. We used a recombinant tissue plasminogen activator (rt-PA) and then performed mechanical thrombectomy using a stent retriever. Angiography revealed left VA occlusion and stagnant flow to the left VA from the right deep cervical artery; therefore, we diagnosed VASS. Within 24 h of the rt-PA injection, the symptoms had dramatically improved, and so we avoided additional antithrombotic agents. Only 13 h later, the patient developed a basilar artery occlusion and died in spite of a repeated mechanical thrombectomy.

Conclusion: Vigilance against early (and sometimes fatal) recurrent stroke induced by VASS is required.

Keywords: Endovascular treatment; Ischemic stroke; Stroke; Vertebral artery stump syndrome.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Diffusion-weighted imaging showing a slightly high-intensity area in the right occipital lobe, right thalamus, and right hippocampus (a and b). MR angiography showing right posterior cerebral artery occlusion at the P1 segment (c).
Figure 2:
Figure 2:
Angiography before mechanical thrombectomy. The right posterior cerebral artery was occluded at the P1 segment (a). Angiography after thrombectomy. Thrombolysis in cerebral infarction 3 complete reperfusion was achieved (b).
Figure 3:
Figure 3:
Angiography of the left subclavian artery. The left VA was occluded from its origin (a). Anterior-posterior view (b) and lateral view (c) of angiography of the left subclavian artery. The left deep cervical artery was anastomosed to the left VA and its antegrade flow in the VA was stagnant. VA: Vertebral artery.
Figure 4:
Figure 4:
Angiography before the second thrombectomy. Basilar artery occlusion was revealed (a). Angiography after thrombectomy. Blood flow to the cerebellum other than the left posterior inferior cerebellar artery was absent (b).
See this image and copyright information in PMC

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