Abstract 124: Vertebral Artery Web as a Rare Cause of Ischemic Stroke in a young male

Abstract

Introduction Vertebral artery web has been rarely identified compared to the frequently reported, carotid artery web as etiology of ischemic stroke. Here we present a young patient with symptomatic vertebral artery web. Methods Case Report Results 35‐year‐old male presented with persistent, intermittent, bilateral visual scintillations lasting 30‐60 seconds for one month. Neurological examination positive for bi nasal superior quadrantanopia. Computed tomography (CT) of head showed patchy hypo density in right posterior circulation artery (PCA) territory. Magnetic resonance imaging (MRI) showed restriction diffusion over bilateral PCA territories right greater than left (image A). MR Angiogram head and neck showed abnormal contour within right vertebral artery in V2 segment compatible with dissection (image B). Patient’s hypercoaguable, inflammatory and rheumatological markers were unremarkable. The patient was started on aspirin 81 mg daily and Plavix 75 mg daily for three weeks followed by aspirin monotherapy. Repeat CT angiogram 11 months later still showed right V1/V2 junction irregularity (image C). DSA performed one month later revealed right cervical vertebral artery web with mild stagnation of blood flow (image D). Patient had no recurrence of symptoms and was continued on aspirin. Conclusion Ischemic stroke is rare in young adults. According to recent studies, prevalence of stroke in young adults’ ranges from 10‐15% of entire population stroke burden. Our case describes a young patient with posterior circulation stroke caused by a vertebral artery web which was confirmed with DSA. Vertebral artery web has limited scientific documentation throughout the literature. A literature review performed by B.J.A. Pereira et al. demonstrated that only 7.3% of vessel webs were found in the vertebral artery, compared to 91.66% in the carotid artery (3). Because of this, a review of medical literature showed limited case reports on treatment and surgical options for vertebral webs causing posterior circulation stroke. Lenck et al. first reported 3 patients with vertebral webs diagnosed by DSA and having MRI show ischemic strokes in the vascular territory were treated with endovascular stenting and had no recurrence of an ischemic event (4). A literature review reported by Pereira demonstrated that out of 23 vessel webs, 13 were treated with supportive care (including antiplatelets or anticoagulation), eight were treated with angioplasty and stenting (which included the vertebral artery web case), and two were treated with surgery (3). In other literature, Lizhang et al (2019) diagnosed an incidental vertebral artery web on DSA for anterior circulation TIA and was treated successfully with DAPT therapy and atorvastatin 20 mg (5).