Embolization of the deep cervical collaterals—a unique endovascular approach to prevent repeated posterior fossa strokes refractory to medical therapy

We present a 69-year-old man with advanced vertebral artery atherosclerotic disease and repeated posterior fossa strokes, refractory to aggressive medical treatment. CT angiogram showed heavily calcified long segment occlusion of the dominant right vertebral artery. Beyond the occlusion, the vertebral artery was reconstituted by hypertrophic deep cervical collaterals which had multiple long and short segments of severe stenosis and antegrade …