Stenting of dominant artery due to symptomatic progression on bilateral vertebral artery dissection: A case report

Abstract

  We report a case in which bilateral vertebral artery (VA) dissection manifesting as cervical pain became symptomatic due to progressive stenosis. Stenting was performed on the dominant left VA. A 51‒year‒old Japanese woman with the chief complaint of posterior cervical pain was diagnosed with bilateral VA dissection based on magnetic resonance angiography (MRA) and was hospitalized. There were no neurological findings, and conservative therapy was initiated. Cerebral angiography and follow‒up MRA were performed. The patient suffered vertigo on day 10 of admission, and magnetic resonance imaging (MRI) revealed an infarction in the right cerebellar hemisphere. MRA demonstrated an occlusion of the right VA and severe stenosis of the left VA. The patient became somnolent, and her symptoms were attributed to brain ischemia. We speculated that ischemia of the brainstem had caused the symptoms. Cerebral angiography on day 12 showing that the dominant left VA was near occlusion. The cerebral blood flow (CBF) of the brainstem was poor. We considered that improvement of the poor CBF would be difficult even with strong medication. The patient underwent stenting of the left VA. The postoperative course was uneventful. Bilateral VA dissection that manifests clinically with a headache and ischemic features is generally cured by medical treatment. However, medication is not effective in cases in which a bilateral VA dissection is accompanied by stenosis. These obstructive changes unusually occur on both sides simultaneously. This case showing that endovascular revascularization was a viable treatment option for symptomatic VA dissection with stenosis.