Symptomatic right vertebral artery web treated with stent implantation and 6-month angiographic follow-up

Vertebral artery (VA) webs are rare intraluminal shelf-like protrusion considered a potential cause of posterior circulation ischemia. Because of its atypical imaging features, it is often misdiagnosed as arterial dissection or atherosclerotic stenosis. Evidence regarding optimal management remains limited; current treatment options include antithrombotic therapy, angioplasty, and stent implantation, yet no clinical studies have established the best treatment strategy.

We report the case of a 68-year-old man with a 3-month history of recurrent dizziness. Digital subtraction angiography (DSA) revealed a web in the right V1 segment with severe stenosis. After exclusion of alternative etiologies, the dizziness was considered to be related to posterior circulation ischemia attributable to the VA lesion. Despite treatment with aspirin, clopidogrel, and atorvastatin, the patient continued to experience recurrent symptoms. He subsequently underwent successful stent implantation, with complete resolution of symptoms. Follow-up angiography at 6 months demonstrated mild in-stent restenosis (ISR) accompanied by stent fracture.

This case highlights that VA web should be considered in patients with unexplained posterior circulation ischemia. Stent implantation may represent an effective treatment option for symptomatic patients refractory to medical therapy; however, the risk of post-procedural restenosis should be recognized. Long-term follow-up and further studies are required to determine optimal management strategies.