Vertebral artery dissection managed by interventional radiology.

Area of Science:

• Neurology
• Vascular Surgery
• Infectious Disease

Background:

• Cerebral artery dissection (CAD) is a rare cause of stroke, particularly in young adults.
• Vertebral artery dissection (VAD) can lead to significant neurological deficits and ischemic events.
• The association between COVID-19 infection and arterial dissection is an emerging concern.

Observation:

• A 21-year-old patient presented with acute neurological symptoms including headache, visual disturbance, and left hand incoordination.
• Diagnosis revealed a left vertebral artery dissection (V3 segment) with multiple cerebellar and cerebral infarcts.
• The patient had no known risk factors for dissection apart from a recent COVID-19 infection.

Findings:

• Medical management with antiplatelets and anticoagulation failed to prevent recurrent ischemic strokes.
• Endovascular coiling was performed after multidisciplinary evaluation, considering patient-specific anatomy and procedural risks.
• At 10-month follow-up, the patient experienced no further strokes, with improving neurological symptoms.

Implications:

• This case suggests COVID-19 may act as a potential trigger for cerebral artery dissection.
• Endovascular coiling can be an effective treatment for refractory cerebral artery dissection unresponsive to medical therapy.
• Further research is warranted to elucidate the link between viral infections and arterial dissection and to establish optimal treatment guidelines.