Acute Placement of Telescoping Open Cell Stents and Thrombectomy for Progressive Symptomatic Vertebrobasilar Dissection: 2-Dimensional Operative Video.

Spontaneous vertebral artery dissections are a rare, but potentially devastating cause of ischemic stroke in young patients. Multiple predisposing factors have been identified including collagen abnormalities and arterial hypertension.1-3Treatment of dissections may vary based on location, presentation, and patient comorbidities. Traditionally, ischemic symptoms are treated more conservatively than their hemorrhagic counterparts.4There are reports in the literature documenting the use of stents for reconstruction of occlusions secondary to vertebral artery dissections.5-14We present the case of a 27-year-old woman who presented after a syncopal event with headaches, ptosis, diplopia, and ataxia. Computed tomography angiogram demonstrated left vertebral artery dissection, near occlusion of the basilar artery, and a hypoplastic right vertebral artery. Despite best medical management, the patient developed worsening weakness and ischemic symptoms, with an MRI revealing new right pontine infarcts. Given her young age and continued progression of symptoms and brainstem strokes, the decision was made to proceed with mechanical thrombectomy and subsequent placement of telescoping open cell stents to treat the vertebral artery dissection. Stent choices include the Neuro form Atlas or Enterprise stents. Paying attention to the landing zones for telescoping stents is critical for optimal placement. Postoperatively, the patient was maintained on her dual antiplatelet therapy regimen and was neurologically intact at the 3-month follow-up. We review the case presentation, angiographic findings, and postoperative course with imaging. The patient provided in-formed consent for the procedure and for inclusion in this submission. The use of an intracranial stent for repair of an intracranial dissection is an off-label use of the device; however, in this situation, it proved to be clinically important in achieving a good clinical outcome.