CASE REPORTS   

Chirurgia 2013 August;26(4):327-32

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Delayed revascularization of a symptomatic vertebral artery dissecting occlusion using the aid of an intracranial transvascular retrograde approach: a technical case report

Deshaies E. M. ¹, Singla A. ¹, Swarnkar A. ²

¹ Department of Neurosurgery SUNY Upstate Medical University, Syracuse, NY, USA; ² Department of Radiology SUNY Upstate Medical University, Syracuse, NY, USA

We report a case of delayed management of a left vertebral artery (VA) occlusion due to dissection in which a unique intracranial transvascular retrograde approach was used to place an antegrade stent across a VA dissection. A 42-year-old previously healthy male was transferred from an outside hospital with history of spontaneous onset headache, dizziness and right sided vision loss that occurred one week prior. His headache and dizziness could only be relieved with hypertensive treatment and in supine position. MRI of the brain demonstrated left occipital infarct and MRA was consistent with left VA dissection at the origin. DSA demonstrated a complete proximal left dominant VA origin occlusion consistent with dissection that reconstituted at the level of mid-cervical spine from muscular branches off the subclavian artery. Due to the inability to pass microwire and microcatheter through VA ostium via an antegrade approach, the left VA was accessed in a retrograde manner through the hypoplastic right VA to locate its origin with a microwire and microcatheter and then those devices were used to guide a left VA stent in an antegrade fashion via the left subclavian artery. A distal protection device was placed distal to the occlusion in order to prevent intracranial clot embolization. The use of an intracranial transvascular retrograde pathway to traverse a vertebral artery origin occlusive dissection combined with antegrade VA origin stent placement for revascularization has not been described previously and can add to the armamentarium of interventionalists encountering similar situations.