title: Extensive bilateral vertebral artery remodeling following treatment of dissection using pipeline embolic device.
abstract: BACKGROUND
  Cerebral artery dissection remains a significant cause of stroke, and the mainstay of treatment has been medical management with anticoagulation, although flow-diverting stents have been used in some cases of arterial dissection resistant to medical management.
  
  
  METHODS
  We present a case report of bilateral vertebral artery stenting using pipeline embolic device flow-diverting stents, after failed medical management of the dissection.
  
  
  RESULTS
  This case demonstrated substantial subsequent vertebral arterial remodeling and good clinical outcome with maintenance of posterior circulation. The patient did not suffer any further strokes or posterior circulation symptoms following vertebral artery remodeling.
  
  
  CONCLUSIONS
  In cases where traditional management of arterial dissection has not been efficacious, flow-diverting stents may be useful in treating dissections of the posterior cerebral circulation, even with bilateral involvement.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden suite 750, Houston, TX 77030, USA.
authors.forename: Bartley
authors.initials: B
authors.lastname: Mitchell
authors.affiliation: Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Momin
authors.affiliation: Neurovascular Center, St. Luke's Episcopal Hospital, Houston, TX 77030, USA.
authors.forename: Liang-Der
authors.initials: LD
authors.lastname: Jou
authors.affiliation: Neurovascular Center, St. Luke's Episcopal Hospital, Houston, TX 77030, USA.
authors.forename: Hashem
authors.initials: H
authors.lastname: Shaltoni
authors.affiliation: Neurovascular Center, St. Luke's Episcopal Hospital, Houston, TX 77030, USA.
authors.forename: Hesham
authors.initials: H
authors.lastname: Morsi
authors.affiliation: Neurovascular Center, St. Luke's Episcopal Hospital, Houston, TX 77030, USA ; Neurovascular Center, St. Luke's Episcopal Hospital, Houston, TX 77030, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Mawad
keywords: Pipeline embolic device; cranial arterial dissection; flow diversion; stent