Endovascular management of symptomatic vertebral artery origin stenosis in the presence of an acute thrombus

Abstract

A woman in her early 60s with hypertension and hyperlipidemia was undergoing investigations for anemia of unknown etiology. She developed a sudden reduction in visual acuity and bilateral visual field impairment. MRI and angiography revealed acute infarcts in the posterior circulation and severe narrowing of the left vertebral artery origin. Digital subtraction angiography demonstrated a high-grade stenosis of the left vertebral artery origin with a thrombus just distal to the stenosis. The patient developed recurrent infarcts while on antithrombotic therapy. The lesion was successfully treated by vertebral artery origin angioplasty and stenting (VOAS) using a flow reversal technique and distal embolic protection. She was discharged to a rehabilitation facility 4 days later without worsening or new neurological deficits. A search of the literature yielded a similar report managed with anticoagulation and subsequent VOAS after complete lysis of the thrombus. Our report highlights the technique, safety and feasibility of VOAS in the presence of a thrombus using a flow reversal technique and distal protection.

Spontaneous Thrombolysis of Multiple Thrombi at Distal Region of Hypoplastic Vertebral Artery After Stent-assisted Angioplasty on Vertebral Artery Origin Stenosis: Angiographic Follow-up

“… 2) The most common mechanism is artery to artery embolism from vulnerable atheromatous plaques at the vertebral artery origin. 1) …”

Crossover balloon technique for vertebral artery thrombus: a novel method

“…This was followed by successful angioplasty and stenting of the stenotic right VA origin 9. Amole et al described a patient with acute thrombus in the VA with stenosis which was treated with VA stenting with flow reversal and distal protection 10. Currently there are no clear guidelines for endovascular treatment if a patient fails medical management.…”

Crossover balloon technique for vertebral artery thrombus: a novel method

“…9 Amole et al described a patient with acute thrombus in the VA with stenosis which was treated with VA stenting with flow reversal and distal protection. 10 Currently there are no clear guidelines for endovascular treatment if a patient fails medical management.…”