Anesthetic management of endovascular stenting in vertebrobasilar dolichoectasia: A case report

Vertebrobasilar Dolichoectasia is a rare pathology characterized by elongation and dilatation of Vertebrobasilar system. It can present as ischemic stroke, cranial nerve deficits or features of brainstem compression. Catastrophic complications such as subarachnoid and intracranial hemorrhage have also been reported. Anesthetic management is challenging due to compromised posterior circulation and brainstem mediated cardiovascular reflexes. We report the case of a 67-year-old female who presented with symptomatic vertebrobasilar dolichoectasia and underwent endovascular stenting under general anesthesia in our hospital. Perioperative management focused on strict hemodynamic stability, minimizing head and neck movements, smooth induction and emergence to prevent blood flow compromise in vertebrobasilar system. A braided stent was placed across the dilated arterial segment with good flow across the stent on check angiogram. Patient showed significant clinical improvement postoperatively and was discharged without any complications. This case highlights the importance of meticulous anesthetic planning, invasive monitoring and controlled hemodynamic management during endovascular procedures in patients with vertebrobasilar dolichoectasia.