Fatal recurrent ischemic stroke caused by vertebral artery stump syndrome
Akinari Yamano1, Yasunobu Nakai2, Kazuki Akutagawa1
1Department of Neurosurgery, University of Tsukuba, Japan.
Background:
Vertebral artery stump syndrome (VASS) develops into recurrent posterior circulation ischemic stroke after ipsilateral vertebral artery (VA) occlusion at its origin.
Case Description:
The patient was a 46-year-old man with the right posterior cerebral artery occlusion. We used a recombinant tissue plasminogen activator (rt-PA) and then performed mechanical thrombectomy using a stent retriever. Angiography revealed left VA occlusion and stagnant flow to the left VA from the right deep cervical artery; therefore, we diagnosed VASS. Within 24 h of the rt-PA injection, the symptoms had dramatically improved, and so we avoided additional antithrombotic agents. Only 13 h later, the patient developed a basilar artery occlusion and died in spite of a repeated mechanical thrombectomy.
Conclusion:
Vigilance against early (and sometimes fatal) recurrent stroke induced by VASS is required.
