Haider Ali S, Gottlich Caleb, Osumah Tijani, Alam Maryam, Khan Umair, Vayalumkal Steven, Leonard Dean, Thakur Richa, Layton Kennith F
Texas A&M College of Medicine.
School of Medicine, Ross University.
Cureus. 2017 May 26;9(5):e1277. doi: 10.7759/cureus.1277.
A significant but less recognized cause of ischemic stroke and transient ischemic attack (TIA) is atherosclerosis of the vertebrobasilar system, which accounts for 20% of ischemic strokes. Pathology of the vertebrobasilar system can present significant challenges in determining the course of treatment. Due to the complexity of the vertebrobasilar system, there is slight disagreement about how to approach patients with atherosclerotic pathology of the posterior circulation. Two such approaches are either stenting of the vertebral or basilar artery or aggressive medical management. Here, we present the case of a 63-year-old male who presented with lightheadedness, diaphoresis, two episodes of loss of consciousness, and the abrupt onset of unilateral right-sided paresis. A computed tomography angiogram (CTA) of the head and neck demonstrated complex posterior circulation vertebrobasilar vascular stenosis and occlusions. There was an unstable clot located at the junction of the vertebral and basilar arteries requiring a carefully nuanced approach. The patient was started on dual antiplatelet therapy and heparin in an effort to resolve the clot. Repeat CTA after five days revealed resolution of the unstable clot; however, the distal intradural right vertebral artery remained occluded and the left vertebral artery remained stenosed. The patient was then treated with a balloon-mounted coronary stent to eliminate the stenosis, which ultimately restored normal posterior fossa flow dynamics. This case serves as a testament to the variability and complexity of vertebrobasilar arteriopathies as well as the benefit of experienced neurointerventionalists in the successful management of these cases.
缺血性中风和短暂性脑缺血发作（TIA）的一个重要但较少被认识到的病因是椎基底动脉系统的动脉粥样硬化，其占缺血性中风的20%。椎基底动脉系统的病理学在确定治疗方案时可能带来重大挑战。由于椎基底动脉系统的复杂性，对于如何治疗后循环动脉粥样硬化病变的患者存在一些分歧。两种这样的方法是对椎动脉或基底动脉进行支架置入或积极的药物治疗。在此，我们介绍一例63岁男性患者，他出现头晕、多汗、两次意识丧失发作以及突然出现的右侧肢体偏瘫。头颈部计算机断层血管造影（CTA）显示后循环椎基底血管存在复杂的狭窄和闭塞。在椎动脉和基底动脉交界处有一个不稳定血栓，需要采取细致入微的方法。患者开始接受双重抗血小板治疗和肝素治疗以溶解血栓。五天后复查CTA显示不稳定血栓已溶解；然而，右侧椎动脉硬膜内远端仍闭塞，左侧椎动脉仍有狭窄。然后该患者接受了球囊扩张冠状动脉支架治疗以消除狭窄，最终恢复了后颅窝正常的血流动力学。这个病例证明了椎基底动脉疾病的多样性和复杂性，以及经验丰富的神经介入专家在成功管理这些病例中的益处。
