PT  - JOURNAL ARTICLE
AU  - Adewumi O Amole
AU  - Mehmet S Akdol
AU  - Clint E Wood
AU  - Salah G Keyrouz
AU  - Eren Erdem
TI  - Endovascular management of symptomatic vertebral artery origin stenosis in the presence of an acute thrombus
AID  - 10.1136/neurintsurg-2011-010038
DP  - 2012 Jul 01
TA  - Journal of NeuroInterventional Surgery
PG  - e11--e11
VI  - 4
IP  - 4
4099  - http://jnis.bmj.com/content/4/4/e11.short
4100  - http://jnis.bmj.com/content/4/4/e11.full
SO  - J NeuroIntervent Surg2012 Jul 01; 4
AB  - 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.