Abstract Details

Title Bilateral IntraCranial Vertebral Artery Stenosis Presenting as Recurrent Prolonged Presyncopal Episodes

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 272

Objective

Background BACKGROUND: Presyncopal or syncopal episodes related to vertebrobasilar stenosis have been described. However these episodes are usually brief, without sequele. We describe a case of bilateral ICVA stenosis presenting as recurrent prolonged presyncopal attacks.

Design/Methods DESIGN/METHODS: A 77 year old female presented with presyncopal episodes. MRI brain demonstrated acute ischemic infarcts in the posterior circulation. MRA brain demonstrated short segment, severe stenosis of both ICVA. She was started on ASA. Six months later, she again presented with similar symptoms of increased frequency and duration. MRI brain again demonstrated new ischemic changes in the same distribution. ASA was changed to Clopidogrel. However she continued to have increasing frequency of presyncopal events, lasting for several hours now on a daily basis necessitating ER visits. Angiogram confirmed the focal stenosis of the bilateral ICVA, with poor collateral supply due to small posterior communicating arteries. The left vertebral stenosis was treated with intracranial stenting, with no poststenting residual stenosis.

Results RESULTS: On the 3 month follow up, the symptoms have resolved with no recurrence.

Conclusions CONCLUSIONS: In the data available regarding ICVA stenosis related ischemic events presenting as presyncopal episodes, the spells were shorter. The severity of the stenosis on imaging in our patient was stable over a one year period. However, the frequency and the duration of the presyncopal spells both increased over this time period. The symptoms resolved after stenting, which validates the hemodynamic pathophysiology of the presyncopal episodes in our patient. VA stenting may be considered for patients who have failed maximized medical management.

Authors/Disclosures
Banu Sundar, MD PRESENTER	Dr. Sundar has nothing to disclose.
Majaz Moonis, MD, FAHA, FAAN (University of Massachusetts, Department of Neurology)	Dr. Moonis has nothing to disclose.
Ajay Wakhloo	No disclosure on file
	No disclosure on file
William E. Klunk, MD, PhD (Western Psychiatric Institute and Clinic)	No disclosure on file

��ɫ��

��ɫ��