A Case of the Left Subclavian-vertebral Artery Bifurcational Stenosis Treated with Transposition of the Vertebral Artery to the Common Carotid Artery Followed by Subclavian Artery Stenting

Abstract

We report a case of the left subclavian-vertebral artery bifurcation lesion treated with a transposition of the vertebral artery (VA) to the common carotid artery followed by subclavian artery (SA) stenting.
A 73-year-old man presented with syncope attack, vertigo, left arm numbness and tingling, particularly with arm activity. Physical examination revealed a diminished left radial pulse and a left subclavian bruit. 3D CT angiography and digital subtraction angiography showed a severe stenosis of the proximal left SA involving the ostium of the left VA. The right VA and bilateral posterior communicating arteries were hypoplastic. First, transposition of the left VA to the left common carotid artery was performed. Ten days after the first operation, stenting to the left SA was performed without any embolic protection device. The postoperative course was uneventful and his symptoms completely disappeared. In this case, prior surgical transposition made the following stent-procedure easier and safer.
The combination of traditional surgical technique and endovascular procedure may be an alternative treatment for VA-SA bifurcation lesion.