Vertebral Artery Stump Syndrome Due to Chronic Complicated Aortic Dissection

Abstract

Vertebral artery (VA) stump syndrome arises when thrombi of an occluded proximal VA propagate to the brain and cause posterior circulation strokes. This phenomenon has been described in limited reports to date. A 39-year-old man with a remote history of endovascular repair of a type B aortic dissection experienced type Ia endoleak causing expansion of the false lumen associated with the dissection. This required combined open debranching and endovascular reconstruction of the thoracic aortic arch. He experienced recurrent posterior circulation strokes 6 months postoperatively. The left VA origin was occluded and remained sequestered to the proximal subclavian artery, in continuity with the false lumen of the dissection. We suspected the aortic dissection extended into the VA and caused the occlusion, while pressure from the false lumen propelled thrombi from the occluded VA stump into the posterior circulation. Repeat imaging shortly after symptom onset showed spontaneous recanalization of the VA. Open surgical ligation of the proximal left VA led to symptom resolution. We describe a unique mechanism of VA stump syndrome due to VA occlusion and pressure waves from an aortic dissection and present the first report of VA stump syndrome treatment by surgical exclusion of the VA.