Vertebral artery stump syndrome (VASS) arises when thrombi of an occluded proximal vertebral artery propagate to the brain and cause posterior circulation strokes

Vertebral Artery Stump Syndrome Due To Chronic Complicated Aortic Dissection: A Case Report.:

Vertebral Artery Stump Syndrome Due To Chronic Complicated Aortic Dissection: A Case Report.

World Neurosurg. 2020 Oct 01;:

Authors: Gupta M, Sagi V, Yekula A, Golts E, Lane JS, Pannell JS

Abstract

BACKGROUND: Vertebral artery stump syndrome (VASS) arises when thrombi of an occluded proximal vertebral artery propagate to the brain and cause posterior circulation strokes. This phenomenon has been described in limited reports to date.

CASE DESCRIPTION: A 39-year-old man with a remote history of endovascular repair of a type B aortic dissection experienced type 1a endoleak causing expansion of the false lumen associated with the dissection. This required combined open debranching and endovascular reconstruction of the thoracic aortic arch. Six months postoperatively he suffered recurrent posterior circulation strokes. The left vertebral artery origin was occluded and remained sequestered to the proximal subclavian artery, in continuity with the false lumen of the dissection. We suspected the aortic dissection extended into the vertebral artery and caused the occlusion, while pressure from the false lumen propelled thrombi from the occluded vertebral artery stump into the posterior circulation. Interestingly, repeat imaging shortly after symptom onset showed spontaneous recanalization of the vertebral artery. Open surgical ligation of the proximal left vertebral artery led to symptom resolution.

CONCLUSIONS: We describe a unique mechanism of VASS due to vertebral artery occlusion and pressure waves from an aortic dissection, as well as the first report of VASS treatment by surgical exclusion of the vertebral artery.



PMID: 33011356 [PubMed - as supplied by publisher]