title: Embolization of the deep cervical collaterals--a unique endovascular approach to prevent repeated posterior fossa strokes refractory to medical therapy.
abstract: We present a 69-year-old man with advanced vertebral artery atherosclerotic disease and repeated posterior fossa strokes, refractory to aggressive medical treatment. CT angiogram showed heavily calcified long segment occlusion of the dominant right vertebral artery. Beyond the occlusion, the vertebral artery was reconstituted by hypertrophic deep cervical collaterals which had multiple long and short segments of severe stenosis and antegrade flow. The ostium of the right vertebral artery was heavily calcified, and multiple attempts to catheterize the vertebral artery were unsuccessful. Flow reversal was eventually achieved in the right vertebral artery by embolizing the hypertrophied deep cervical artery which reconstituted the right vertebral artery. The patient has remained asymptomatic since the procedure for a follow-up period of 12 months.
authors.affiliation: Department of Neuroradiology, Health Sciences Centre, Winnipeg, Manitoba, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mammen
authors.forename: Reza
authors.initials: R
authors.lastname: Vosoughi
authors.forename: Vikram
authors.initials: V
authors.lastname: Wadhwa
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D002536:Cerebral Arteries; D002560:Cerebrovascular Circulation / Q000502:physiology; D003097:Collateral Circulation; D003388:Cranial Fossa, Posterior; D004351:Drug Resistance; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator
keywords: Atherosclerosis; CT Angiography; Coil; Posterior fossa; Stroke