Early diagnosis and rapid thrombectomy with stent placement in distal vertebral artery stenosis (Mori Type C) with mild symptoms.

Abstract

Background: Vertebrobasilar artery occlusion (VBAO) is a life-threatening condition with often nonspecific symptoms, making early diagnosis challenging. Timely intervention is crucial, especially in cases involving distal vertebral artery stenosis. Case Report: A 65-year-old male presented with acute vertigo, dizziness, and visual disturbances, along with ipsilateral sixth cranial nerve palsy. His medical history included a treated abdominal aortic aneurysm, hypercholesterolemia, and hypertension. CT angiography (CTA) revealed an occlusion in the V4 segment of the right vertebral artery. CT perfusion imaging showed minimal perfusion delay in the right brainstem. The patient received intravenous thrombolysis (IVT) with tenecteplase, followed by mechanical thrombectomy (MT), partial recanalization was achieved. However, digital subtraction angiography (DSA) identified a critical stenosis (>90%) responsible for the occlusion, consistent with arteriosclerotic disease. Following intravenous administration of 500 mg acetylsalicylic acid, a Biotronik Orsiro 2.25 × 9 mm drug-eluting stent was placed, achieving complete recanalization (eTICI 3). Neurologic symptoms resolved completely post-intervention, and the patient received 300 mg clopidogrel. He was discharged with an MRS score of 0 within 3 days. Conclusion: This case highlights the effectiveness of a multimodal approach (IVT, MT, and stenting) in treating distal vertebral artery occlusion (Mori Type C). Early diagnosis and timely endovascular intervention led to rapid symptom resolution and complete neurological recovery. Follow-up ultrasound at 4 months confirmed good bilateral vertebral artery perfusion without restenosis, supporting the potential long-term benefits of this multimodal treatment approach. This case underscores the importance of advanced imaging for early detection and the role of thrombectomy and stenting in optimizing patient outcomes.