PMC7656025_01
(a and b) Magnetic resonance images showing left cerebellar infarction and poor flow through the left vertebral artery. (c) Left subclavian artery angiography showing dissection from the vertebral artery ostium to the V2 segment, vertebral artery ostial stenosis (star), and collateral vessels (arrow).
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F1
He visited the same hospital, and a second MRI revealed left cerebellar infarction and poor flow to the left VA [Figures 1a and b]. Digital subtraction angiography (DSA) revealed dissection from the VA ostium to the V2 segment and anastomoses between the VA and collateral vessels distal to the VA dissection [Figure 1c].
(a) Magnetic resonance images showing left occipital lobe infarction. (b and c) Left subclavian artery angiography showing vertebral artery flow from the collateral vessels (arrowhead), antegrade vertebral artery slow flow (arrow) from the vertebral artery ostium, and vertebral artery ostial occlusion (star).
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F2
MRI revealed left occipital lobe infarction [Figure 2a]. One month later, DSA revealed complete VA ostial occlusion and V2 segment dissection, in which the antegrade VA flowed slowly through collateral vessels [Figures 2b and c].
(a and b) Magnetic resonance images showing left cerebellar infarction and right occipital lobe infarction. (c) Left subclavian artery angiography showing antegrade vertebral artery slow flow from the collateral vessels. (d) Right vertebral artery angiography showing the dominant right vertebral artery.
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F3
Two months later, the patient experienced vertigo, and an MRI revealed left cerebellar and right occipital lobe infarction [Figures 3a and b]. DSA produced a similar image as the one produced previously [Figures 3c and d].
(a and b) Intraoperative findings reveal the V3 segment (arrow) and antegrade flow using Doppler ultrasonography. The V3 segment of the vertebral artery is clipped. VA ostial occlusion because the dissection can be approached extravascularly.
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F4
We clipped the VA using Yasargil Titanium Mini Clips (FT720T) [Figure 4].
Magnetic resonance imaging and right vertebral artery angiography. No cerebral infarction and good backflow from the vertebral artery (right to left) can be observed. (a and b) Postoperative day 1. (c) Postoperative day 4. (d and e) Postoperative 20 months.
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F5
No ischemic episodes occurred during the 20-month postsurgical follow-up period [Figure 5].