Fatal recurrent ischemic stroke caused by vertebral artery stump syndrome

Akinari Yamano; Yasunobu Nakai; Kazuki Akutagawa; Haruki Igarashi; Kazuaki Tsukada; Toshitsugu Terakado; Kazuya Uemura; Eiichi Ishikawa

doi:10.25259/SNI_384_2021

Fatal recurrent ischemic stroke caused by vertebral artery stump syndrome

Surg Neurol Int. 2021 Sep 6:12:445. doi: 10.25259/SNI_384_2021. eCollection 2021.

Authors

Akinari Yamano¹, Yasunobu Nakai², Kazuki Akutagawa¹, Haruki Igarashi², Kazuaki Tsukada¹, Toshitsugu Terakado¹, Kazuya Uemura², Eiichi Ishikawa¹

Affiliations

¹ Department of Neurosurgery, University of Tsukuba, Japan.
² Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.

Abstract

Background: Vertebral artery stump syndrome (VASS) develops into recurrent posterior circulation ischemic stroke after ipsilateral vertebral artery (VA) occlusion at its origin.

Case description: The patient was a 46-year-old man with the right posterior cerebral artery occlusion. We used a recombinant tissue plasminogen activator (rt-PA) and then performed mechanical thrombectomy using a stent retriever. Angiography revealed left VA occlusion and stagnant flow to the left VA from the right deep cervical artery; therefore, we diagnosed VASS. Within 24 h of the rt-PA injection, the symptoms had dramatically improved, and so we avoided additional antithrombotic agents. Only 13 h later, the patient developed a basilar artery occlusion and died in spite of a repeated mechanical thrombectomy.

Conclusion: Vigilance against early (and sometimes fatal) recurrent stroke induced by VASS is required.

Keywords: Endovascular treatment; Ischemic stroke; Stroke; Vertebral artery stump syndrome.

Publication types

Case Reports