Authors
Daisuke Yamada, Yoshinori Akiyama, Ryo Akiyama, Hidetoshi Matsukawa, Fuminori Shimizu, Nobuyuki Sakai
Published in
Journal of neuroendovascular therapy. Volume 20. Issue 1. Epub Sep 30, 2026.
Abstract
Endovascular revascularization is increasingly used to treat symptomatic acute intracranial vertebral artery (ICVA) occlusion, with reported clinical benefit. In contrast, chronic total occlusion (CTO) is managed primarily with conservative therapy, and the indications for and efficacy of endovascular revascularization remain uncertain.
A 74-year-old man with right vertebral artery (VA) occlusion and left VA stenosis was followed at our outpatient clinic. He presented with a 40-day history of dizziness and gait disturbance. MRI showed no new acute infarction, whereas MRA demonstrated bilateral VA occlusion. However, automated perfusion imaging (RAPID; iSchemaView, Golden, CO, USA) identified a large perfusion abnormality, leading to a diagnosis of symptomatic ICVA CTO. Urgent endovascular revascularization was performed. A small postoperative cerebellar infarction developed without new neurological deficits. Symptoms on admission improved with medical therapy and rehabilitation, and he was discharged home 14 days after the procedure; the perfusion abnormality had nearly resolved. At 2 months after hospital discharge, the patient remained asymptomatic, with no symptom recurrence.
Endovascular revascularization for symptomatic ICVA CTO resulted in a favorable outcome. Automated perfusion imaging may help identify appropriate candidates for this treatment.
PMID:
42825306
Bibliographic data and abstract were imported from PubMed on 02 Oct 2026.
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