Intracranial Vertebrobasilar Artery Dissection with Silent Rapid Progression
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Updated: Aug 18, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Hsu-Huai Chiu1, Chih-Ping Chung2, Feng-Chi Chang3
1Department of Neurology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.
Insights
Intracranial vertebrobasilar artery dissection (iVBD) can progress silently. Early vascular imaging follow-up is crucial for high-risk patients to guide timely endovascular intervention.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Intracranial vertebrobasilar artery dissection (iVBD) is a serious condition with a risk of vessel progression.
- Determining optimal timing for follow-up imaging and intervention in iVBD is clinically important.
Observation:
- A case of a 48-year-old woman with iVBD presenting with transient limb weakness and cerebellar infarct.
- Initial MRA revealed dissection of the left vertebral artery extending to the basilar artery.
- Despite no new symptoms, follow-up imaging within a week showed critical narrowing of the dissected vessels.
Findings:
- iVBD can progress rapidly and severely without concurrent clinical deterioration.
- Early, close vascular imaging surveillance is essential for detecting silent progression.
Implications:
- This case highlights the need for prompt follow-up imaging in iVBD patients, especially those at high risk.
- Timely endovascular intervention, such as stenting, can restore blood flow and prevent further complications.
Purpose:
Intracranial vertebrobasilar artery dissection (iVBD) is a potentially lethal disease, and progression of the dissected vessels is not uncommon. Our report is aimed at providing further clinical experience of the timing of follow-up vascular imaging or endovascular intervention in iVBD patients.
Case Report:
We report a case of iVBD with silent rapid progression. The 48-year-old woman presented as transient right limbs weakness. Brain MRI showed a small acute infarct over the left cerebellum, and MRA revealed a short segment of dissection over the left distal vertebral artery extending to proximal basilar artery. With no new clinical symptoms and signs, follow-up of vascular imaging within 1 week showed progressive critical narrowing of the dissected vertebrobasilar arteries. The blood flow of the vertebrobasilar system was restored by endovascular stenting.
Conclusion:
iVBD might progress without clinical manifestations. Early follow-up of vascular imaging should be considered in the patients with high risk for progression.
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