2025 Volume 53 Issue 4 Pages 248-253
In symptomatic vertebrobasillar artery stenosis, neither endovascular nor surgical interventions have proven efficacy, and revascularization may be necessary in cases in which the condition is refractory to medical therapy. We report the case of a 67-year-old male with hemodynamic cerebellar and brainstem infarctions due to left vertebral artery V4 occlusion and severe right V4 stenosis, causing repeated syncope with neck rotation to the left. Catheter insertion into the right V1 during digital subtraction angiography (DSA) induced immediate syncope. Despite receiving conservative therapy for 3 weeks, the patient’s syncope persisted. Concerns regarding ischemic risk during prolonged catheterization prompted the decision to perform bypass surgery, which successfully resolved the patient’s syncope.
