Neurointervention.  2013 Feb;8(1):41-45. 10.5469/neuroint.2013.8.1.41.

Acute Vertebral Artery Origin Occlusion Leading to Basilar Artery Thrombosis Successfully Treated by Angioplasty with Stenting and Intracranial Fibrinolysis

Affiliations
  • 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. mnoriaki0817@yahoo.co.jp
  • 2Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
  • 3Department of Neurology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.

Abstract

There are few reports describing stroke due to the acute occlusion of the vertebral artery (VA) origin successfully treated by endovascularily. The authors report a case of 78-year-old man suffering from stroke owing to acute VA origin occlusion associated with contralateral hypoplastic VA leading to basilar artery (BA) thrombosis. Cerebral angiography demonstrated that the right VA was occluded at its origin, the left VA was hypoplastic, and BA was filled with thrombus. The occlusion of VA origin was initially passed through with a microcatheter and microwire. Hereafter, angioplasty was performed followed by stenting with a coronary stent. The VA origin was successfully recanalized. Next, a microcatheter was navigated intracranially through the stent and fibrinolysis was performed for BA thrombus. The patient's symptoms gradually improved postoperatively. Stroke due to acute VA origin occlusion leading to BA thrombosis was successfully treated by angioplasty and stenting followed by intracranial fibrinolysis.

Keyword

Vertebral artery origin; Occlusion; Stroke; Angioplasty with stenting; Fibrinolysis

MeSH Terms

Angioplasty
Basilar Artery
Cerebral Angiography
Fibrinolysis
Stents
Stress, Psychological
Stroke
Thrombosis
Vertebral Artery

Figure

  • Fig. 1 MR DWI acquired on the day of symptom showed high-intensity in the right cerebellum, faint high-intensity in the right brain stem, and several small high spots (A). MRA showed faint visualization of BA and both SCAs (B). Right subclavian artery angiogram disclosed the VA origin occlusion (C). Left VA angiogram showing hypoplastic VA that ended at extracranial portion (D). Lateral view of right CCA angiogram showing that the distal right VA was supplied with collateral flow from external carotid artery system. Basilar artery was filled with thrombus although it supplied via antegrade flow from the right VA and retrograde collateral flow from posterior communicating artery (E). Right subclavian artery angiogram describing the microcatheter which crossed occlusive site (F). Right subclavian artery angiogram acquired after angioplasty and stenting showed the reconstruction of VA origin (G). Right VA angiogram, injected by lesion-crossed microcatheter, demonstrated that thrombus at BA was clearly described while right SCA was occluded (H). Right VA angiogram after fibrinolysis for BA, showing the antegrade flow of VA/BA was improved, although BA thrombus still partially remained and the right SCA was occluded (I). MRA acquired 1 week later clearly demonstrated the right VA, BA and left SCA, despite poor visualization of right SCA distal (J).


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