A Patient with Hyperperfusion-related Cerebral Hemorrhage after Neuroendovascular Treatment for Vertebral Artery Stenosis

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Objective: We report a patient with hyperperfusion-related cerebral hemorrhage after neuroendovascular treatment for symptomatic vertebral artery stenosis.

Case Presentation: The patient was a 75-year-old male, who presented with repeated attacks of vertigo. He was diagnosed with vertebral-basilar insufficiency. Subsequently, medical treatment involving the administration of an antiplatelet drug was performed, but brainstem infarction developed. Cerebral angiography showed occlusion of the left vertebral artery and stenosis at the origin and intracranial area of the right vertebral artery. Cerebral blood flow scintigraphy revealed a reduction in cerebellar blood flow as well as the site of infarction. The patient was considered to be resistant to medical treatment, and angioplasty was performed at two stenotic sites of the left vertebral artery. Despite strict blood pressure control, brainstem hemorrhage occurred 4 hours after surgery. The postoperative cerebral blood flow scintigraphy findings suggested hyperperfusion-related hemorrhage.

Conclusion: For endovascular treatment of vertebral artery stenosis with cerebral blood flow failure, postoperative hyperperfusion-related cerebral hemorrhage may not be prevented by blood pressure control alone. Therapeutic strategies, such as a staged angioplasty, should be established based on cerebral blood flow examination findings.