Abstract
A 59-year-old female presented with symptoms concerning for left hemispheric transient ischemic attacks. Multiple imaging modalities confirmed the presence of acute left sided cerebral infarcts along with complete left internal carotid artery occlusion. Following discharge on appropriate medical therapy, the patient represented weeks later with similar complaints. Angiography confirmed left internal carotid artery occlusion and identified a right vertebral artery supplying the entire contralateral hemisphere. A segment of severe stenosis at the vertebral artery origin was identified and stented. Post-operatively, the patient recovered well and was discharged home without significant neurological deficits. During follow-up, in-stent restenosis developed at 7 months requiring additional intervention with balloon angioplasty and re-stenting. To date the patient suffers no significant neurologic deficits, is maintained on maximal medical therapy, and continues follow up with serial exams and ultrasound imaging.
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