Endovascular management of symptomatic vertebral artery dissection achieved using stent angioplasty and emboli protection device

Extracranial vertebral artery (VA) dissection may lead to significant arterial stenosis, occlusion, or pseudoaneurysm formation with subsequent hemodynamic and embolic infarcts. To prevent thromboembolic complications, anticoagulation with intravenous heparin followed by oral warfarin has been recommended for all patients with acute dissections, regardless of the type of symptoms, unless there are contra-indications. Nevertheless, anticoagulation is not innocuous, may be contra-indicated or may be ineffective to prevent symptoms or dissection progression. Because it is effective and less invasive than other surgical procedures, endovascular treatment of VA dissection has recently attracted interest. We present a case of a traumatic VA dissection, presenting with multiple embolic infarctions that was managed with protected stent-assisted angioplasty. Protected stent-assisted VA angioplasty has not been previously reported and appears to be a safe, effective and immediate method of restoring vessel lumen integrity and should be considered in the therapy of selected cases of VA dissection.