PMC9479644_01
(a) Cerebral magnetic resonance angiography (MRA) shows left vertebral artery (VA) occlusion. (b) Cervical MRA does not depict the right VA orifice.
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F1
MRA showed left VA occlusion [Figure 1a] and no right VA orifice was depicted [Figure 1b].
(a) The right anterior oblique view of the vertebral artery (VA) angiogram shows pseudo-occlusion of the right VA orifice with faint anterograde flow (arrow). (b) Lateral view of the right VA lateral angiogram reveals that the right VA is reconstructed with a collateral pathway through the deep cervical arteries (double arrows). (c) The left subclavian angiogram reveals left VA occlusion at the C2 level (arrowhead).
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F2
Digital subtraction angiography showed right VA orifice pseudo-occlusion with faint anterograde flow [Figure 2a]. The right VA was reconstructed with distal inflow through collateral pathways through the deep cervical arteries [Figure 2b]. The left vertebral angiogram revealed left VA occlusion at the C2 level [Figure 2c] and the posterior communicating artery was not visualized on either right or left common carotid artery angiograms.
(a) A balloon expandable bare-metal stent is placed at the vertebral artery (VA) origin. (b) Good revascularization is achieved after postballoon dilatation. (c) Intracranial VA angiogram shows good depiction of the posterior circulation without distal embolism.
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F3
A balloon expandable bare-metal stent (4 mm diameter, 15 mm length, PALMAZ Genesis; Cordis, Dublin, Ireland) was placed [Figure 3a] because balloon PTA did not provide sufficient dilatation. The stent was postdilated with a 4 mm balloon (Aviator; Cordis) and good revascularization was obtained [Figure 3b]. Intracranial VA angiography showed good depiction of the posterior circulation without distal embolism [Figure 3c].