J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):281-286. 10.7461/jcen.2014.16.3.281.

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

• Kim HS
• Huh CW
• Kim DS
• Mok JH
• Kim IS
• Kim SH

• KMID: 1963168
• DOI: http://doi.org/10.7461/jcen.2014.16.3.281

Abstract

Vertebral artery hypoplasia (VAH) can be easily overlooked if the contralateral side vertebral artery is intact, because of compensation by the contralateral artery or cerebral collateral network. The clinical relevance and hemodynamic impact of VAH is still controversial. However, VAH has recently been considered a risk factor for posterior circulation ischemia. Ischemic stroke is seldom caused by free floating thrombi (FFT) in the artery. Pathophysiology of FFT has not yet been clarified. The state of reduced blood flow such as a vertebral artery origin stenosis may cause FFT. Their instability may make them sources of recurrent artery to artery embolism. Patients with FFT will require appropriate medical and endovascular treatment. The current case illustrates a short-term angiographic change of spontaneous thrombolysis of VAH and multiple thrombi at the distal region of the stenosed lesion after stent-assisted angioplasty for a vertebral artery origin stenosis.

Keyword

Vertebral artery hypoplasia; Free floating thrombi; Endovascular treatment; Vertebral artery origin stenosis

MeSH Terms

Angioplasty*
Arteries
Compensation and Redress
Constriction, Pathologic*
Embolism
Follow-Up Studies*
Hemodynamics
Humans
Ischemia
Risk Factors
Stroke
Vertebral Artery*

Figure

• 

  Fig. 1 (A,B) Diffusion weighted magnetic resonance imaging (MRI) of the brain shows focal high signal intensities in the right cerebellar hemisphere, occipital area, and splenium of the corpus callosum. (C) No significant steno-occlusive lesions are detected on intracranial MR angiography (MRA). (D) Gadolinium-enhanced cervical MRA demonstrates the prominent left vertebral artery and invisible long segment of the proximal right vertebral artery.

• 

  Fig. 2 (A) Pre-stenting angiogram of the right vertebral artery shows severe stenosis of the right vertebral artery origin (white arrowhead) and multiple filling defects distal to the stenosis (black arrowheads). (B) Angiogram obtained immediately after vertebral artery origin stent placement shows significant improvement in the stenosis (white arrow) and continued multiple filling defects in the right vertebral artery. (C) A two-week follow-up angiogram shows a patent vertebral artery orifice after placement of a stent and the previously noted multiple thrombi in the right vertebral artery had disappeared.

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