Extracranial vertebral artery endovascular reconstruction in the setting of subacute total occlusion: case report and review of literature

Vertebral artery insufficiency is a significant cause of posterior circulation strokes (PCS). Currently, there are no clear guidelines for the endovascular treatment of extracranial vertebral artery (VA) stenosis. This case report presents a 59-year-old male with a history of left VA stenting who was on antiplatelet therapy and presented to our outpatient clinic with minimal symptoms. Computed tomography angiography (CTA) revealed bilateral vertebral artery occlusion at their origins. The patient subsequently developed acute neurological symptoms, and neuroimaging confirmed a new PCS with hemorrhagic transformation. Vertebral stump syndrome was suspected. The patient underwent successful endovascular reconstruction of the left VA. Following the procedure, he demonstrated clinical improvement, with only mild residual deficits at follow-up. This case highlights the challenges of endovascular intervention, including device selection, anatomical complexity, and procedural risks. Further studies are warranted to optimize treatment strategies and clarify the potential benefits of intervention in patients with occlusive lesions, particularly those with complex vascular anatomy