Korean J Radiol.  2015 Jun;16(3):678-681. 10.3348/kjr.2015.16.3.678.

Stenting for Symptomatic Vertebral Artery Stenosis Associated with Bilateral Carotid Rete Mirabile: The Long-Term Clinical and Angiographic Outcome

• Baek JH
• Kim BM

• KMID: 2155541
• DOI: http://doi.org/10.3348/kjr.2015.16.3.678

Abstract

Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rete mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.

Keyword

Rete mirabile; Stenting; Carotid artery disease

MeSH Terms

Adult
Angioplasty, Balloon
Carotid Arteries/pathology/*radiography/*surgery
Cerebral Angiography
Female
Humans
*Stents
Syncope/etiology
Treatment Outcome
Vertebrobasilar Insufficiency/*radiography/*surgery
Young Adult

Figure

• 

  Fig. 1 22-year-old woman presenting with recurrent syncope. Left internal (A), external (B), right internal (C), and external carotid (D) angiograms showed typical appearance of carotid rete mirabile. E. Source images of MR angiogram showed probable hypoplastic carotid canal (arrows). F. Left vertebral angiogram showed severe degree of stenosis at left vertebral artery V4 portion (arrow). Collateral supply to bilateral internal carotid artery was not prominent (arrowheads). Right vertebral artery was occluded (not shown). G. After stenting (arrow), left vertebral artery supplied markedly augmented collaterals to bilateral internal carotid artery. H, I. 4-year follow-up carotid angiograms showed that bilateral carotid rete mirabile had regressed to faint visualization angiographically. J. Left vertebral angiogram showed that stented left vertebral artery supplied whole brain via bilateral posterior communicating arteries without in-stent restenosis.

Reference

1. Mahadevan J, Batista L, Alvarez H, Bravo-Castro E, Lasjaunias P. Bilateral segmental regression of the carotid and vertebral arteries with rete compensation in a Western patient. Neuroradiology. 2004; 46:444–449.

2. Castro S, Abreu P, Azevedo E, Silva ML. A new pattern of arterial rete compensation of segmental basilar agenesis associated with carotid retia mirabilia: a case report (2010: 1b). Eur Radiol. 2010; 20:1024–1028.

3. Mikami T, Takahashi A, Houkin K. Carotid rete mirabile associated with subarachnoid hemorrhage. Neurol Med Chir (Tokyo). 2005; 45:201–204.

4. Lee SY, Cha SH. Bilateral carotid and vertebral rete mirabile presenting with a prominent anterior spinal artery mimicking a spinal dural AV fistula at MRI. Korean J Radiol. 2011; 12:740–744.

5. Sahin H, Cinar C, Oran I. Carotid and vertebrobasilar rete mirabile: a case report. Surg Radiol Anat. 2010; 32:95–98.