Article ID: 11211
The patient was a 52-year-old man who had developed left vertebral artery dissection at the age of 37 and received conservative treatment. Although the fusiform enlargement of the left vertebral artery remained, no imaging changes were observed. At the age of 51, he underwent partial gastrectomy for advanced gastric cancer. Postoperative chemotherapy consisted of tegafur, gimeracil, and oteracil, but multiple liver metastases were detected; hence, the combination therapy was switched to ramucirumab, which is a molecularly targeted drug that inhibits angiogenesis, plus nab-paclitaxel. After starting the new chemotherapy regimen with ramucirumab, he developed a severe headache, and head MRI revealed a new dissection of the contralateral right vertebral artery. The patient did not experience bleeding or ischemia, and occlusion of the right vertebral artery was confirmed, so the patient was followed up with conservative treatment. Although there has been a report of aortic dissection associated with anti-VEGF drugs, such as ramucirumab, there have been no reports of vertebral artery dissection in patients on ramucirumab. The present patient had a history of unilateral vertebral artery dissection, and ramucirumab administration was suspected to be related to the onset of contralateral vertebral artery dissection.
