Rapidly successive, symptomatic, bilateral, spontaneous vertebral artery dissections: treatment with stent reconstruction

Background: Vertebral artery dissection has been increasingly identified as a cause of ischemic stroke in young adults. This condition is typically secondary to trauma, with spontaneous VA dissection accounting for only a minority of cases. We report the case of a patient with bilateral symptomatic spontaneous VA dissections, presenting in rapid succession. Each ictal event was successfully managed with stent reconstruction and antiplatelet therapy. Case Description: A 40-year-old gentleman, with no preceding trauma or apparent inciting event, presented with the acute onset of imbalance, dysarthria, right-sided paresthesias, headache, dysphagia, and dysmetria. Workup revealed a right VA dissection with pseudoaneurysm formation, which was treated with multiple stents. He was scheduled for a 3-week follow-up angiogram and maintained on aspirin and clopidogrel. Three days before his appointment, the patient presented with severe headache and significant worsening of his dysarthria and right-sided dysmetria. Imaging demonstrated a healing right VA pseudoaneurysm, but his left VA was newly dissected with an associated pseudoaneurysm. This lesion was also successfully treated in a similar fashion. The patient did well postoperatively. Follow-up angiography demonstrated excellent vessel patency and pseudoaneurysm stabilization/regression. Conclusion: A case of rapidly successive, symptomatic bilateral VA dissections is presented. Ictal events occurred at separate time points and were successfully managed with stent-reconstruction and antiplatelet therapy. Through reporting our experience, we hope to raise awareness regarding this rare condition in young adults.