Structural Restoration of an Unruptured Vertebral Artery Dissection Following Autologous Mesenchymal Stem Cell...

Vertebral artery dissection (VAD) is a recognized cause of ischemic stroke, and current management relies on antithrombotic therapy that is not specifically directed at structural repair of the arterial wall. We report a man in his mid-50s who presented with a sudden, severe right occipital headache after a golf swing and had a history of a contralateral left VAD 16 years earlier. High-resolution vessel wall magnetic resonance imaging and angiography showed an acute, unruptured dissection of the right V4 segment with an intramural hematoma, and serial imaging documented progression of the true-lumen stenosis before treatment. Because the lesion was progressing and stenting of the intracranial V4 segment carried a high risk of iatrogenic rupture, autologous bone marrow-derived mesenchymal stem cells (MSCs) were administered as a well-tolerated adjunct to continued antithrombotic therapy, in two systemic infusions at 8 weeks and 10 months after onset. The patient had an uneventful clinical course with no infusion-related adverse events, and follow-up imaging at 11 months showed resorption of the intramural hematoma and restoration of a normal-appearing lumen and wall. Because spontaneous healing of unruptured VAD cannot be excluded, this single, uncontrolled observation cannot establish that MSC therapy caused the recovery; nonetheless, the treatment was well-tolerated and the favorable course warrants evaluation in adequately controlled studies before any therapeutic role of MSCs in VAD can be defined.