Endovascular recanalization of symptomatic long-segment nonacute vertebral artery occlusion: a case report.

Abstract

Background: Vertebral artery occlusive disease is a leading cause of posterior circulation ischemic stroke. Endovascular recanalization has been described as a viable treatment option for individuals with symptomatic vertebral artery occlusion who fail to respond to appropriate medicinal therapy. However, endovascular recanalization of symptomatic long-segment nonacute vertebral artery blockage is associated with significant surgical risk and the possibility of perioperative complications.

Case presentation: Despite rigorous pharmacologic therapy, a patient with a protracted segmental left vertebral artery blockage continues to experience cerebral hypoperfusion and neurologic impairments. Digital subtraction angiography (DSA) revealed a stump at the left vertebral artery ostium of segment V1, the right V4 segment was obviously congenitally thin, and a small amount of reflux was observed at the distal end of the left V4 segment. The posterior communicating artery was closed. We considered the diagnosis of left vertebral artery blockage (near V1 to V4). The patient underwent balloon dilatation of the occlusion and stenting. Finally, revascularization was successfully performed for long-segment occlusion of the left vertebral artery. DSA indicated complete segmental filling 3 months and 2 years after the patient received medication, and there were no new neurologic complaints throughout the 2-year follow-up period.

Conclusion: After detailed evaluation and screening, recanalization of long-segment vertebral artery occlusion in the nonacute phase is feasible.