A case of vertebral artery stump syndrome treated by parent artery occlusion via collateral anastomosis

The treatment for vertebral artery stump syndrome (VASS) remains controversial. Here, we report a case of VASS in which cervical vertebral artery (VA) occlusion was performed. A 35-year-old man was admitted for left VA cerebellar infarction caused by left cervical VA dissection with severe stenosis on angiography, and was administered aspirin (100 mg/day). One month after discharge, the patient experienced recurrent stroke with cerebellar infarction. Digital subtraction angiography revealed that the origin of the left VA was occluded and that the VA received antegrade and retrograde flow via the left ascending and deep cervical arteries. The patient was diagnosed with a retrograde flow-induced thrombosis and recurrent embolic stroke. Planned parent artery occlusion (PAO) was performed using a left radial approach under local anesthesia. The patient did not experience stroke recurrence after the procedure. PAO via collateral anastomosis is an option for recurrent stroke treatment when anastomosis via the muscle branch is well developed.