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Positional vertebral artery recanalization during neck flexion causing recurrent ischemic stroke.

Takahiro Kitahara¹, Shimpei Aoyama¹, Makoto Hayase¹

¹Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan.

Radiology Case Reports

|June 18, 2025

Summary

Positional vertebral artery (VA) occlusion can cause posterior circulation ischemic stroke. This case highlights rare VA recanalization when the neck is flexed, preventing further strokes.

Keywords:

Dynamic angiography Ischemic stroke Osteophyte Vertebral artery Warfarin

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Area of Science:

Neurology
Vascular Neurology
Neuroimaging

Background:

Positional vertebral artery (VA) occlusion is a rare cause of ischemic stroke.
It occurs when neck posture leads to reversible VA blockage, affecting posterior circulation.
Understanding these mechanisms is crucial for diagnosing and managing recurrent strokes.

Observation:

A 70-year-old male experienced recurrent posterior circulation cerebral infarction.
His left VA was occluded in the neutral neck position due to C5 osteophyte compression.
Dynamic cerebral angiography showed left VA recanalization upon neck flexion.

Findings:

This case demonstrates positional VA recanalization, where occlusion in the neutral position resolves with neck flexion.
This phenomenon is uncommon, with the VA typically occluding during specific dynamic movements.
The patient remained stroke-free for two years on warfarin therapy.

Implications:

Dynamic evaluation of the vertebral arteries is essential for diagnosing recurrent ischemic stroke, even if occlusion is noted in the neutral position.
Identifying positional VA occlusion aids in targeted treatment strategies.
This case underscores the importance of dynamic imaging in evaluating posterior circulation stroke etiology.