A case report of intraluminal thrombus in proximal vertebral artery
10.3969/j.issn.1002-0152.2025.04.007
- VernacularTitle:椎动脉起始部腔内血栓1例
- Author:
Yang DING
1
;
Yijie CHEN
;
Xu ZHENG
;
Yigang CHEN
;
Jinhua ZHANG
Author Information
1. 浙江大学医学院附属邵逸夫医院护理部(杭州 310018)
- Publication Type:Journal Article
- Keywords:
Vertebral artery;
Intraluminal thrombus;
Antiplatelet;
Vertebral artery ostium stenosis;
Vertebral ar-tery ostium stenting;
Endovascular treatment
- From:
Chinese Journal of Nervous and Mental Diseases
2025;51(4):243-245
- CountryChina
- Language:Chinese
-
Abstract:
Intraluminal thrombus(ILT)at the vertebral artery origin is rare and often missed due to atypical symptoms.However,it poses a high risk of artery-to-artery embolism and severe posterior circulation ischemia.This article reports a case of missed diagnosis of ILT to improve the diagnostic ability.The patient,a 49-year-old male was admitted to emergency department with sudden dizziness accompanied by nausea for 12 hours.Head CT suggested posterior circulation ischemia.Patient was given aspirin 0.2 g/d and atorvastatin 20 mg/d orally and discharged from the hospital.Head MRI in the outpatient department showed a recent infarct in the right cerebellar hemisphere next day.On the 28th,dizziness recurred,accompanied by unsteady walking and right-sided hemisensory numbness.The symptoms persisted and did not improve.He was admitted to the hospital on the 29th.Cervical CTA showed severe stenosis at the origin of the right vertebral artery,filling defect in the distal lumen combined with the Donut sign.Thus,ILT was diagnosed.The drug treatment regimen was adjusted to aspirin 100 mg/d combined with clopidogrel 75 mg/d for a total of 15 weeks.High-resolution MRI of the cervical blood vessels in the outpatient department showed occlusion of the V1-V2 segment of the right vertebral artery.On November 2,endovascular treatment was performed under local anesthesia.At 90 days and 6 months of follow-up after the operation,no recurrence of cerebral ischemia events occurred,and the mRS score was 0.This case highlights the need for vigilance toward ILT in posterior circulation ischemia when initial imaging is inconclusive.Early dynamic CTA(5-7 days)combined with dual antiplatelets may prevent thrombus progression and improve outcomes.
