Abstract Details

Title Dissected Duplicated Origin of Left Vertebral Artery as a Rare Cause of Recurrent Posterior Circulation Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 14-012

Objective With this report we are highlighting rare anatomic variation that can hide the etiology of recurrent stroke and treatment method we deployed.

Background The duplicated origin of the left vertebral artery(VA) is a rare anatomical variation, where the artery has two distinct origins. Typically one limb(lateral) originate from left subclavian artery and the other(medial) from the aortic arch. We present a case in which dissection of medial limb was the etiology of multiple posterior circulation ischemic strokes.

Design/Methods Retrospective review and description of clinical case. Literature review on topic of this anatomical variation.

Results We present a case of 61 year-old male who had 3 previous posterior circulation strokes, including two basilar thrombectomies. Both thrombectomies were performed via left VA access from left subclavian artery. He was noticed to have transition of diameter in distal V2 segment left VA without dissection flap or flow limitation. Right VA was hypoplastic. Extensive work up had failed to reveal any other underlying etiology. He was on mono antiplatelet treatment after first stroke (14 months prior), dual antiplatelet treatment (2 months prior) and apixaban with dual antiplatelet treatment after third stroke (one month prior). During follow-up elective diagnostic catheter angiogram, aortic arch run revealed tapered stump of medial limb of duplicated left VA. Left VA lateral limb injection revealed partial recanalization of distal end of medial limb where it anastomoses with lateral limb in distal V2 segment. Medial limb is thought to be dissection occluded and likely source of recurrent emboli. It was treated with flow diverter stent extending from distal end of lateral limb into distal V2 segment of left VA, covering anastomotic point with diseased medial end.

Conclusions This rare anatomic variation can be harbinger of stroke etiology and requires extra attention to all modalities of vessel imaging.

Authors/Disclosures
Khushi Patel, MD PRESENTER	Miss Patel has nothing to disclose.
Daniel Tonetti, MD	Dr. Tonetti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Route 92 Medical. Dr. Tonetti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for IRRAS.
Jane Khalife, MD (Thomas Jefferson University Hospital)	Dr. Khalife has nothing to disclose.
Tudor G. Jovin, MD (Cooper University Healthcare)	Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Contego Medical. Dr. Jovin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Several law firms. Dr. Jovin has stock in Corindus. Dr. Jovin has stock in Methinks. Dr. Jovin has stock in Viz.ai. Dr. Jovin has stock in Route92. Dr. Jovin has stock in FreeOx Biotech. Dr. Jovin has stock in Galaxy. Dr. Jovin has stock in Kandu. The institution of Dr. Jovin has received research support from Stryker. The institution of Dr. Jovin has received research support from Medtronic.
Hamza Shaikh, MD	Dr. Shaikh has nothing to disclose.
Pratit D. Patel, MD (Capital Health)	Dr. Patel has nothing to disclose.

��ɫ��

��ɫ��