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Case Reports
. 2022 Aug 26:13:382.
doi: 10.25259/SNI_515_2022. eCollection 2022.

Endovascular vertebral artery orifice angioplasty for the prevention of acute ischemic stroke following vertebral artery stump syndrome

Ai Okamoto  1 , Ichiro Nakagawa  1 , Masashi Kotsugi  1 , Shohei Yokoyama  1 , Shuichi Yamada  1 , Young-Soo Park  1 , Hiroyuki Nakase  1
Affiliations
Case Reports

Endovascular vertebral artery orifice angioplasty for the prevention of acute ischemic stroke following vertebral artery stump syndrome

Ai Okamoto et al. Surg Neurol Int. .

Abstract

Background: Vertebral artery stump syndrome (VASS) involves repeated acute ischemic stroke (AIS) in the posterior circulation following vertebral artery (VA) orifice occlusion. The presence of VA orifice occlusion makes endovascular thrombectomy (EVT) difficult to achieve and leads to posterior circulation stroke with unfavorable functional outcomes. Here, we report a case of endovascular VA orifice angioplasty for the right VA pseudo-occlusion to prevent AIS following VASS pathology.

Case description: In a 76-year-old man presenting with dizziness, angiography revealed right pseudo-occluded VA at the origin concomitant with the left VA occlusion. The posterior circulation depended on the right VA through collateral flow to the distal portion. Prophylactic endovascular VA angioplasty for the right pseudo-occluded VA at the orifice was achieved to prevent AIS with tandem lesions. In the present case, endovascular VA angioplasty can prevent acute embolic stroke in the posterior circulation following EVT-resistant VASS pathology.

Conclusion: Clinicians should be aware that EVT is not easy in AIS following VASS due to access difficulties and the treatment strategy should be carefully considered.

Keywords: Acute ischemic stroke; Endovascular angioplasty; Mechanical thrombectomy; Posterior circulation; Vertebral artery stump syndrome.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
(a) Cerebral magnetic resonance angiography (MRA) shows left vertebral artery (VA) occlusion. (b) Cervical MRA does not depict the right VA orifice.
Figure 2:
Figure 2:
(a) The right anterior oblique view of the vertebral artery (VA) angiogram shows pseudo-occlusion of the right VA orifice with faint anterograde flow (arrow). (b) Lateral view of the right VA lateral angiogram reveals that the right VA is reconstructed with a collateral pathway through the deep cervical arteries (double arrows). (c) The left subclavian angiogram reveals left VA occlusion at the C2 level (arrowhead).
Figure 3:
Figure 3:
(a) A balloon expandable bare-metal stent is placed at the vertebral artery (VA) origin. (b) Good revascularization is achieved after postballoon dilatation. (c) Intracranial VA angiogram shows good depiction of the posterior circulation without distal embolism.
See this image and copyright information in PMC

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