Abstract
Objective: We report a case of acute occlusion of the intradural vertebrobasilar artery due to atherosclerotic vertebral artery (VA) stenosis treated by emergent thrombectomy and balloon angioplasty followed by intracranial stenting at chronic phase.
Case presentation: A 68-year-old male was admitted to our hospital with dysarthria, nausea, and hemianopsia. Diffusion weighted image (DWI) MRI showed acute infarction at the cerebellar hemisphere and occipital lobe, and MRA showed poor flow signal of bilateral VA and basilar artery (BA). After admission, his symptom was progressive with sudden disturbance of the consciousness, suggesting acute BA occlusion. DSA demonstrated complete occlusion of the intracranial vertebrobasilar artery between distal portion of posterior inferior cerebellar artery and proximal portion of anterior inferior cerebellar artery with right VA hypoplasia. The rapid thrombectomy with the Penumbra system was performed, which resulted in successful recanalization with left VA stenosis, and then balloon angioplasty was added. After 6 weeks, stent deployment for the treatment of persistent left VA stenosis was performed and obtained good VA dilatation. The patient improved to modified Rankin Scale 1 postoperatively, and no recurrent symptoms were observed during the 1-year follow-up period.
Conclusion: Thrombosis of atherosclerotic VA and subsequent vertebrobasilar artery occlusion can cause fatal stroke. Emergent thrombectomy and balloon angioplasty followed by stenting at chronic stage were considered to be useful for such case.
