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(Circulation. 2001;103:e61.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Percutaneous Stenting of a Vertebral Artery Supplying the Entire Brain

Khaled M. Ziada, MD; Marco Roffi, MD; Jay S. Yadav, MD

From the Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to Jay S. Yadav, MD, Cardiology Department, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail Yadavj@cesmtp.ccf.org

A63-year-old woman was referred for evaluation of a transient ischemic attack with right arm and leg involvement. On examination, she had a right neck bruit. The head CT scan showed a small, old ischemic infarction in the periventricular area of the right frontal lobe. Digital substraction angiography revealed a total occlusion of both internal carotid arteries, a severe stenosis of the origin of the right vertebral artery (Figure, upper left), and an atretic left vertebral artery. The right vertebral artery supplied the vertebrobasilar circulation and the right and left hemispheres (Figure, right). Because of this functionally unique cerebral blood supply and location of the stenosis, the patient was not considered a candidate for surgical revascularization. Accordingly, she underwent percutaneous stenting using adjunctive abciximab with excellent angiographic results (Figure, lower left). During the brief balloon inflation (<15 s) the patient did not develop neurological or hemodynamic symptoms. The hospital stay was uneventful, and she was discharged the next day. At 6 months, she had no recurrent neurological events. To our knowledge, this is the first report describing successful percutaneous stenting of a dominant vertebral artery supplying the entire brain.

View larger version (111K): [in this window] [in a new window]   Figure 1. Cerebral digital substraction angiography. Upper left panel demonstrates extracranial portion of right vertebral artery with a severe stenosis at its origin. Right panel shows intracranial portion of same vessel supplying both hemispheres. Lower left panel shows result after stenting.