Endovascular One-stage Bilateral Vertebral Artery Occlusion for a Patient with Atlanto-axial Fracture Associated with Bilateral Vertebral Artery Injury

Abstract

Objective: We report a patient who underwent one-stage bilateral vertebral artery (VA) occlusion to prevent recurrent ischemic stroke after atlanto-axial fracture with traumatic bilateral VA injuries (VAIs).

Case Presentation: A 78-year-old male with cervical pain and horizontal nystagmus after head injury as he fell down at the stairs. Cervical CT revealed atlanto-axial fracture without severe dislocation. MRI showed acute ischemic stroke in bilateral cerebellar hemisphere. Emergent cerebral angiography revealed bilateral VAIs. Based on the findings of the balloon test occlusion, one-stage bilateral VA occlusion was performed without any complication. After the procedure, there was no new neurological symptom or ischemic lesion on MRI.

Conclusion: For patients with traumatic VAI, treatments should be considered based on both the presence of ischemic symptoms and angiographic morphologies of lesions.