Bilateral Symptomatic Extracranial Vertebral Artery Dissection Treated with Unilateral Flow Diverter and Follow-Up with Complete Bilateral Reconstruction and Good Clinical Outcome

Vertebral artery dissection (VAD) is an uncommon cause of stroke in the general population (approximately 2%), with bilateral dissections occurring in approximately 13% of cases. The VAD can become a source of embolization throughout the posterior circulation. The goal of treatment is to minimize the risk and extent of neurological deficit and to restore cerebral circulation. Medical therapy is considered the first-line treatment for patients with VAD. Contraindications to conservative management include hemodynamic compromise of the posterior circulation, bilateral dissection, and persistent embolization despite medical therapy (i.e., failure of medical therapy). Endovascular treatment of a VAD aims to reconstruct the dissected artery and is safe and effective. We describe a 32-year-old female patient with bilateral spontaneous VADs treated with unilateral flow diversion to the left vertebral artery (VA) with complete reconstruction of both VAs at follow-up. The treatment of extracranial VAD is the topic of this chapter.