Facial steal syndrome: identification and endovascular management

We describe a case of intraprandial vertebro-basilar insufficiency secondary to posterior cerebral circulation ischemia. Secondary collateralization was seen from facial and external carotid artery branches to the posterior circulation causing facial arterial steal during mastication. This condition was treated endovascularly. Occluded common and external carotid arteries were revascularized via angioplasty and stenting. The patient was able to undergo coronary artery bypass and right hip replacement in the following two months without cerebrovascular complications.