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Case report
Embolization of the deep cervical collaterals—a unique endovascular approach to prevent repeated posterior fossa strokes refractory to medical therapy
  1. Thomas Mammen1,
  2. Reza Vosoughi2,
  3. Vikram Wadhwa1
  1. 1Department of Neuroradiology, Health Sciences Centre, Winnipeg, Manitoba, Canada
  2. 2Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr T Mammen, Department of Radiology, Health Sciences Centre, 820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9; tmammen{at}gmail.com

Abstract

We present a 69-year-old man with advanced vertebral artery atherosclerotic disease and repeated posterior fossa strokes, refractory to aggressive medical treatment. CT angiogram showed heavily calcified long segment occlusion of the dominant right vertebral artery. Beyond the occlusion, the vertebral artery was reconstituted by hypertrophic deep cervical collaterals which had multiple long and short segments of severe stenosis and antegrade flow. The ostium of the right vertebral artery was heavily calcified, and multiple attempts to catheterize the vertebral artery were unsuccessful. Flow reversal was eventually achieved in the right vertebral artery by embolizing the hypertrophied deep cervical artery which reconstituted the right vertebral artery. The patient has remained asymptomatic since the procedure for a follow-up period of 12 months.

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