Background: Vertebrobasilar artery occlusion (VBAO) is a life-threatening condition with often nonspecific symptoms, making early diagnosis challenging. Timely intervention is crucial, especially in cases involving distal vertebral artery stenosis. Case Report: A 65-year-old male presented with acute vertigo, dizziness, and visual disturbances, along with ipsilateral sixth cranial nerve palsy. His medical history included a treated abdominal aortic aneurysm, hypercholesterolemia, and hypertension. CT angiography (CTA) revealed an occlusion in the V4 segment of the right vertebral artery. CT perfusion imaging showed minimal perfusion delay in the right brainstem. The patient received intravenous thrombolysis (IVT) with tenecteplase, followed by mechanical thrombectomy (MT), partial recanalization was achieved. However, digital subtraction angiography (DSA) identified a critical stenosis (>90%) responsible for the occlusion, consistent with arteriosclerotic disease. Following intravenous administration of 500 mg acetylsalicylic acid, a Biotronik Orsiro 2.25 × 9 mm drug-eluting stent was placed, achieving complete recanalization (eTICI 3). Neurologic symptoms resolved completely post-intervention, and the patient received 300 mg clopidogrel. He was discharged with an MRS score of 0 within 3 days. Conclusion: This case highlights the effectiveness of a multimodal approach (IVT, MT, and stenting) in treating distal vertebral artery occlusion (Mori Type C). Early diagnosis and timely endovascular intervention led to rapid symptom resolution and complete neurological recovery. Follow-up ultrasound at 4 months confirmed good bilateral vertebral artery perfusion without restenosis, supporting the potential long-term benefits of this multimodal treatment approach. This case underscores the importance of advanced imaging for early detection and the role of thrombectomy and stenting in optimizing patient outcomes.
AhmedRADmytriwAAPatelAB, et al.Basilar artery occlusion: a review of clinicoradiologic features, treatment selection, and endovascular techniques. Intervent Neuroradiol2023; 29(6): 748–758.
2.
SparacoMCiolliLZiniA. Posterior circulation ischaemic stroke-a review part I: anatomy, aetiology and clinical presentations. Neurol Sci2019; 40(10): 1995–2006.
3.
KniepHCSpornsPBBroocksG, et al.Posterior circulation stroke: machine learning-based detection of early ischemic changes in acute non-contrast CT scans. J Neurol2020; 267(9): 2632–2641.
4.
HoyerCSzaboK. Pitfalls in the diagnosis of posterior circulation stroke in the emergency setting. Front Neurol2021; 12: 682827.
5.
RajendramPIkramAFisherM. Combined therapeutics: future opportunities for co-therapy with thrombectomy. Neurotherapeutics2023; 20(3): 693–704.
6.
JovinTGLiCWuL, et al.Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion. N Engl J Med2022; 387(15): 1373–1384.
7.
TaoCLiRZhuY, et al.Endovascular treatment for acute basilar artery occlusion: a multicenter randomized controlled trial (ATTENTION). Int J Stroke2022; 17(7): 815–819.
8.
LinCHLiebeskindDSOvbiageleB, et al.Efficacy of endovascular therapy for basilar and vertebral artery occlusion: a systematic review and meta-analysis of randomized controlled trials. Eur J Intern Med2023; 110: 22–28.
9.
PaikSWYangHJSeoYJ. Sixth cranial nerve palsy and vertigo caused by vertebrobasilar insufficiency. J Audiol Otol2020; 24(3): 157–160.
10.
GottesmanRFSharmaPRobinsonKA, et al.Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurol2012; 18(5): 245–254.
11.
MarkusHSMichelP. Treatment of posterior circulation stroke: acute management and secondary prevention. Int J Stroke2022; 17(7): 723–732.
12.
BaikSHKimJYJungC. A review of endovascular treatment for posterior circulation strokes. Neurointervention2023; 18(2): 90–106.
13.
LeeGYYangCKangCH, et al. Mechanical thrombectomy for hyperacute vertebrobasilar ischemic stroke via nondominant vertebral artery : clinical experience and considerations. J Korean Neurosurg Soc. 2024.
14.
EberhardtONaegeleTRaygrotzkiS, et al.Stenting of vertebrobasilar arteries in symptomatic atherosclerotic disease and acute occlusion: case series and review of the literature. J Vasc Surg2006; 43(6): 1145–1154.
15.
LiuLZhaoXMoD, et al.Stenting for symptomatic intracranial vertebrobasilar artery stenosis: 30-day results in a high-volume stroke center. Clin Neurol Neurosurg2016; 143: 132–138.
16.
EberhardtONaegeleTRaygrotzkiS, et al.Stenting of vertebrobasilar arteries in symptomatic atherosclerotic disease and acute occlusion: case series and review of the literature. J Vasc Surg2006; 43(6): 1145–1154.
17.
PanYElmJJLiH, et al.Outcomes associated with clopidogrel-aspirin use in minor stroke or transient ischemic attack: a pooled analysis of clopidogrel in high-risk patients with acute non-disabling cerebrovascular events (CHANCE) and platelet-oriented inhibition in New TIA and minor ischemic stroke (POINT). JAMA Neurol2019; 76: 1466–1473.
