Endovascular treatment of a patient with traumatic dissection lesions of both vertebral arteries obtained during chiropractic manipulation

The observation of endovascular treatment of a 34-year-old woman with bilateral dissection lesions of vertebral arteries in V4-segments with occlusion of the right vertebral artery and right posterior inferior cerebellar artery, severe stenosis of the left vertebral artery caused by chiropractic manipulation in the neck region is described. There are intensive staticolocomotor and dynamic coordinating insufficiency, severe neck pain, headache, severe dizziness, Wallenberg syndrome, moderate central tetraparesis. MRI of the brain on the DWI Isotropic identified the hyperintensive round-shaped foci in the right hemisphere of the cerebellum, in the right side of cerebellum worm, in the right side of the medulla oblongata and in the right side of the pons (DWI BSS 3). Selective cerebral angiography was performed an hour after the clinic manifestation. Simultaneously, balloon angioplasty of severe dissection stenosis was performed in the V4-segment of the left vertebral artery by the compliant balloon-catheter Scepter C. In 18 hours from the development of vertebral artery dissection, self-expending stent LVIS was implanted into the left vertebral artery in the zone of dissection lesion. On the control angiograms: the left vertebral artery patency is restored without stenosis all along. The stent is fully opened. A second contrast contour is determined outside the stent in the dissection zone. All the arteries of the vertebrobasilar basin above the vertebrobasilar junction are passable. The V4-segment of the right vertebral artery is contrasted through the vertebrobilar junction. There was a rapid regression of neurological symptoms in the postoperative period. Only mild hypoesthesia on the right side in the outer Sölder’s zone, light coordination disorders on the right were remained. Control selective cerebral angiography revealed recanalization of the right vertebral artery and the right posterior cerebellar artery. But distal basin of the right posterior cerebellar artery is very poorly. The left vertebral artery is passable all over, but in the place of the former dissection, two equivalent arterial «sleeves» were formed according to the fenestration type. One «sleeve» is formed by a stent, the other — outside. All arteries of the vertebrobasilar basin are contrasted. The mild hemihepesthesia on the right side of the face in the outer Sölder’s zone, light coordination disorders on the right are remained. Implantation of the self-expanding stent LVIS allowed to restore the dominant vertebral artery and restrict ischemic brain damage in the brain stem and cerebellum in a patient with a both vertebral arteries dissection lesion caused by chiropractic neck manipulations

Endovascular treatment of the patient with vascular type of Ehlers–Danlos syndrome with bilateral dissection stenoses and aneurysms in V3- andV4- segments of vertebral arteries

A case of treatment of a patient with type 4 of Ehlers–Danlos syndrome and bilateral dissection stenoses and aneurysms in V3and V4-segments of vertebral arteries is described. Also another vascular anomaly was verified: the aberrant right subclavian artery (arteria lusoria). Сerebral angiography with dynamic rotation of the neck revealed a bow hunter's syndrom, which consists in the restriction of blood flow in the right vertebral artery when the head is turned to the left. Stage-by-stage endovascular reconstruction of both vertebral arteries was performed. Firstly, LVIS stent was implanted in the left vertebral artery on the level of the dissection lesion. Then, the aneurysm of the left vertebral artery was embolized by detachable coils. Balloon angioplasty was performed in the stented segment with the compliance balloon-catheter Scepter. On the series of angiograms: the aneurysm is totally excluded, the stenosis of the artery is eliminated. After 1 month, the second stage of endovascular treatment in the same volume in the right vertebral artery was performed. At attempts of a hemostasis with the vascular closure device Аngioseal were unsuccessful in both operations. Hemostasis was successfully performed by manual compression of the puncture site. A mutation in the gene COL3A1, responsible for the synthesis of procollagen III type, was confirmed by Ehlers–Danlos syndrome of type 4 (vascular type) at the subsequent genotyping of the patient. The patient's neurological symptoms regressed to a great extent. Endovascular methods can be effective in the treatment of vertebral arteries dissection lesions in patients with vascular type of Ehlers–Danlos syndrome