Vertebral Artery Stenting With Flow Reversal

Abstract

Case report: A 47-year-old man was admitted with recurrent symptoms of dysarthria, diplopia, vertigo, and drop attacks. Workup revealed Ͼ90% stenosis of the left vertebral artery at its origin with poststenotic dilatation (Fig 1). The vertebral artery was 4 mm in diameter. The plaque appeared to have significant embolic potential. The right common femoral artery was accessed with short 9F sheath, and patient was anticoagulated with intravenous heparin (100 U/kg body weight). The left subclavian artery was cannulated using headhunter catheter. The catheter was advanced over the wire to mid brachial artery. Wire exchanged to stiff wire. MoMa flow reversal guide catheter (Medtronic, Minneapolis, Minn) was advanced over the stiff wire until the trailing balloon was engaged in the left subclavian artery. The leading balloon was positioned in left subclavian artery and kept deflated. The trailing balloon in left subclavian artery was inflated after