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Percutaneous transluminal angioplasty for vertebral artery origin stenosis under the flow-reversal protection using
Fukutaro Ohgaki1, Nagatsuki Tomura2, Takashi Shuto1
1Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan.
Insights
Vertebral artery origin stenosis (VAOS) can cause stroke. Percutaneous transluminal angioplasty (PTA) with flow reversal protection using Mo.MA™ Ultra offers a safe endovascular treatment option for VAOS, preventing distal embolism.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Vertebral artery origin stenosis (VAOS) is a significant cause of posterior circulation ischemic stroke.
- Current primary treatment involves dual antiplatelet therapy, but endovascular treatment (EVT) effectiveness is emerging.
- This case highlights a novel EVT approach for symptomatic VAOS.
Observation:
- A 78-year-old male patient presented with acute posterior cerebral artery occlusion.
- Mechanical thrombectomy achieved recanalization, revealing right VAOS as the cause of artery-to-artery embolism.
- Percutaneous transluminal angioplasty (PTA) using Mo.MA™ Ultra for flow reversal protection was performed electively.
Findings:
- The PTA procedure successfully treated the VAOS.
- Antegrade flow in the right vertebral artery (VA) was significantly improved post-procedure.
- The Mo.MA™ Ultra system effectively prevented distal embolism during the intervention.
Implications:
- Flow-reversal protection with Mo.MA™ Ultra is a feasible EVT strategy for VAOS.
- This technique mitigates the high risk of distal embolism associated with crossing VAOS lesions.
- It is particularly advantageous in cases with robust contralateral vertebral artery flow supporting basilar artery supply during protection.
Background:
Vertebral artery origin stenosis (VAOS) is a major cause of ischemic stroke of the posterior circulation. Aggressive medical treatment using dual antiplatelet therapy is the most common treatment approach to symptomatic VAOS; however, the effectiveness of endovascular treatment (EVT) for VAOS has recently been reported. Here, we report a case of VAOS treated with percutaneous transluminal angioplasty (PTA) under flow reversal protection using Mo.MA™ Ultra.
Case Description:
The patient was a 78-year-old man. He underwent mechanical thrombectomy for acute right posterior cerebral artery occlusion, and recanalization was achieved. Subsequently, artery-to-artery (A-to-A) embolism caused by the right VAOS was revealed as the etiology. PTA under the flow-reversal protection using Mo.MA™ Ultra was performed electively, and the VAOS and antegrade flow of the right vertebral artery (VA) improved.
Conclusion:
In EVT for symptomatic VAOS, lesion cross for distal protection device placement is considered to create a high risk of distal embolism due to the anatomic and clinicopathological characteristics of VAOS lesions, especially in A-to-A embolism cases. The flow-reversal protection using Mo.MA™ Ultra can be performed with EVT to prevent distal embolism with lesion cross by retrograde flow of the VA. This method is feasible, especially for cases in which antegrade flow to the basilar artery through the developed contralateral VA is anticipated during the Mo.MA™ Ultra protection.
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