Abstract:
BACKGROUND AND IMPORTANCE:This article describes delayed endovascular revascularization in a patient with clinical and radiographic evidence of posterior circulation hemodynamic failure in the setting of intracranial occlusive lesions. CLINICAL PRESENTATION:A 48-year-old man presented with a 6-week history of progressive headache, nausea, and ataxia. Bilateral intracranial vertebral artery occlusions and a left posterior inferior cerebellar artery stroke were diagnosed, and the patient began warfarin therapy. Despite these measures, the patient developed dense lower cranial neuropathies, including severe dysarthria, decreased left-sided hearing acuity, and left facial droop. He presented at this point for endovascular evaluation. The patient underwent successful revascularization with intravascular Wingspan stents (Boston Scientific, Natick, Massachusetts) in a delayed fashion (approximately 6 weeks after his initial stroke presentation). His neurological syndrome stabilized and began to improve slowly. CONCLUSION:Patients with arterial occlusion should be evaluated acutely for potential revascularization. In the posterior circulation, clinical progression may supplant physiological imaging in the assessment of hemodynamic collapse. A subpopulation of patients will present with progressive deficits distinct from extracranial manifestations of vertebrobasilar insufficiency; these patients should be considered for delayed revascularization.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Ogilvy CS,Khalessi AA,Hauck EF,Shannon LR 2nd,Hopkins LN,Levy EI,Siddiqui AHdoi
10.1227/NEU.0b013e3182186811subject
Has Abstractpub_date
2011-07-01 00:00:00pages
E251-6; discussion E256issue
1eissn
0148-396Xissn
1524-4040pii
00006123-201107000-00029journal_volume
69pub_type
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