Delayed endovascular revascularization in a patient with progressive neurological deterioration from bilateral intracranial vertebral artery occlusions: case report.
Journal Article (Journal Article)
BACKGROUND AND IMPORTANCE: This article describes delayed endovascular revascularization in a patient with clinical and radiographic evidence of posterior circulation hemodynamic failure in the setting of intracranial occlusive lesions. CLINICAL PRESENTATION: A 48-year-old man presented with a 6-week history of progressive headache, nausea, and ataxia. Bilateral intracranial vertebral artery occlusions and a left posterior inferior cerebellar artery stroke were diagnosed, and the patient began warfarin therapy. Despite these measures, the patient developed dense lower cranial neuropathies, including severe dysarthria, decreased left-sided hearing acuity, and left facial droop. He presented at this point for endovascular evaluation. The patient underwent successful revascularization with intravascular Wingspan stents (Boston Scientific, Natick, Massachusetts) in a delayed fashion (approximately 6 weeks after his initial stroke presentation). His neurological syndrome stabilized and began to improve slowly. CONCLUSION: Patients with arterial occlusion should be evaluated acutely for potential revascularization. In the posterior circulation, clinical progression may supplant physiological imaging in the assessment of hemodynamic collapse. A subpopulation of patients will present with progressive deficits distinct from extracranial manifestations of vertebrobasilar insufficiency; these patients should be considered for delayed revascularization.
Full Text
Duke Authors
Cited Authors
- Ogilvy, CS; Khalessi, AA; Hauck, EF; Shannon, LR; Hopkins, LN; Levy, EI; Siddiqui, AH
Published Date
- July 2011
Published In
Volume / Issue
- 69 / 1
Start / End Page
- E251 - E256
PubMed ID
- 21796070
Pubmed Central ID
- 21796070
Electronic International Standard Serial Number (EISSN)
- 1524-4040
Digital Object Identifier (DOI)
- 10.1227/NEU.0b013e3182186811
Language
- eng
Conference Location
- United States