Abstract 162: Vertebral Artery Stenting for Compression Stenosis Due to Cervical Facet Hypertrophy

Background Vertebrobasilar insufficiency can be caused by various pathologic conditions including atherosclerosis, dissections, steal phenomenon, etc. While endovascular treatment of those conditions is well‐established, stenting of vertebral artery (VA) compression stenosis due to cervical facet hypertrophy is uncommon. We describe a case of VA stenting to address the symptomatic stenosis caused by mass effect from cervical facet hypertrophy. Method A 78‐year‐old male with a history of deep venous thrombosis and paroxysmal atrial fibrillation presented with several episodes of transient loss of awareness triggered by neck movement from side to side. This has restricted his neck mobility. Computed tomography angiography (CTA) revealed stenosis of the left VA at the C3‐C4 level secondary to cervical facet hypertrophy. Decision was made to treat this problem via endovascular means. Results Access was achieved via the right femoral artery, and a guide catheter was parked in the left subclavian artery just proximal to the left VA ostium. The left VA was selected with an intermediate catheter, and angiography revealed a moderate stenosis at the cervical V2 segment, with no evidence of atherosclerosis nor dissection. 3D rotational angiography confirmed the stenosis being caused by a C3‐C4 facet hypertrophy impinging on the artery. We proceeded with angioplasty and stenting at the point of stenosis, using a balloon‐mounted Papyrus stent. Follow‐up angiography showed improvement in the degree of stenosis. At 1‐month follow‐up, patient was symptom‐free, with no recurrence of his symptoms. Conclusion This case illustrates vertebral stenting a potential therapeutic option for vertebral artery compression stenosis caused by cervical facet hypertrophy. Although residual stenosis remained, the intervention improved the patient's symptoms.