6/26/2023 0 Comments Wallenburg pica syndromeThe vertebral artery was ligated, and the patient developed a Wallenburg syndrome. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. In one patient the stenosis was distal to the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient, the plaque was at the origin of the PICA. In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. Knowledge of existing (embryonic) variants in neurovascular anatomy is essential when planning and performing acute neurointerventional procedures. PPTA is a persistent embryological carotid–basilar connection. Ten days after intervention patient was discharged scoring optimal EMV with only a mild facial and left hand paresis remaining. After passage of the proximal ICA occlusion, the right PCA and SCA were recanalized through the PPTA, with a single thrombectomy procedure. Stent-retriever assisted thrombectomy was not considered possible through the hypoplastic proximal BA. Computed tomography angiography showed an acute occlusion of the right internal carotid artery (ICA), the PPTA, distal basilar artery (BA), right posterior cerebral artery (PCA), and right superior cerebellar artery (SCA). The patient presented with an acute left sided hemiparesis and loss of consciousness (Glasgow coma score of 5). We describe a case of intra-arterial treatment (IAT) of acute posterior circulation occlusion in a patient with a persistent primitive trigeminal artery (PPTA).
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