Recurrent Vertebral Arteries Dissection (P6.219)

Objective: We report a case of recurrent vertebral arteries dissection. Background: Vertebral artery dissection (VAD) is an infrequent but important cause of stroke in younger patients. Spontaneous VAD is thought to have an underlying structural defect of the arterial wall. Recurrent dissections are rare, particularly in the same artery. Design/Methods: Case report and literature review. Results: A 39 year-old man with a history of HTN and hyperlipidemia presented with right sided neck pain, visual symptoms and dizziness. MRI showed small right cerebellum and left occipital ischemic stroke. CTA revealed long segment proximal right VAD. He was treated with warfarin, an antihypertensive agent and a statin. Repeat CTA in 4 months showed healing of the vertebral artery and warfarin was switched to aspirin. 7 months later he developed neck pain. CTA showed a new right VAD at the level of C1. Warfarin was restarted. The dissection healed and MRI showed no new infarcts. 27 months later he presented with neck pain and new left VAD at the level of C3 to C6. His symptoms resolved quickly. He was continued on warfarin. Repeat CTA showed resolution of arterial wall abnormality. 29 months after the last VAD he again developed neck pain. CTA showed a new right VAD at the level of C2. Over the years search for definite cause has been elusive with no evidence of fibromuscular dysplasia or connective tissue disorders. His BP overall has been reasonable controlled. Family history significant for grandmother with history of stroke and father with CAD and CABG. The patient never smoked. The patient is currently asymptomatic. Conclusions: Recurrence of VAD is rare, particularly in the same artery at different locations. To our knowledge, no case of three discrete episodes within the vertebral artery has been reported. We decided to keep the patient on indefinite anticoagulation. Disclosure: Dr. Bronstein has nothing to disclose. Dr. Danesh has nothing to disclose. Dr. Torres has nothing to disclose. Dr. Chao has nothing to disclose. Dr. Petrovic has nothing to disclose. Dr. Ashikian has nothing to disclose. Dr. Arbuckle has nothing to disclose.