Endovascular Treatment of Isolated PICA Insufficiency. A Case Report

The vertebral artery terminating in the posterior inferior cerebellar artery is rare but it may cause cerebellar infarction when total occlusion of the vertebral artery occurs. Therefore treatment of vertebral artery stenosis in these patients is crucial. Surgical treatment of osteal vertebral artery stenosis is possible but is associated with approximately 4% mortality and up to 20% risk of procedural complications including perioperative VA occlusion, Horner syndrome, lymphatic injury and injury to the phrenic, vagus, laryngeal and thoracic nerves. Therefore percutaneous angioplasty with or without stent placement is emerging as an alternative treatment method with a high success rate and good initial angiographic outcome. Percutaneous angioplasty of the VA origin is associated with an approximately 15% restenosis rate. Stent placement is believed to decrease the incidence of elastic recoil and restenosis. Herein we present a rare symptomatic case with an anomalous, small-caliber right VA terminating in the PICA which was successfully treated with a drug-eluting stent.