Three episodes of basilar tip occlusion necessitating thrombectomies and a vertebral artery sacrifice in a patient with subclavian artery dissection distal to the vertebral artery origin: a case report

Background: While acute occlusion of the subclavian artery (SCA) proximal to the vertebral artery (VA) origin is an uncommon but recognized cause of embolic stroke, an occlusion distal to the VA is rare and can be easily overlooked. Case Description: We describe the clinical presentation and evaluation of a previously healthy 56-year-old woman who experienced four life-threatening posterior circulation strokes within 1 month, three of which led to basilar artery (BA) occlusions requiring thrombectomies. Workup revealed an occlusion of the right SCA located less than 1 cm distal to the VA origin. After the fourth posterior circulation ischemic event and three BA thrombectomies, a decision was made to sacrifice the right VA origin. Following the sacrifice of the origin of the right VA, she recovered with minimal neurological deficits and regained complete functionality with no further ischemic episodes in the following 2 years. Conclusions: This case highlights an exceedingly rare etiology of posterior circulation stroke: an occlusion of the SCA distal to the VA origin. Though unconventional, the decision to sacrifice the VA origin proved crucial in this context and underscores the need for consideration in similar scenarios. Her recovery emphasizes the safety and effectiveness of recurrent thrombectomy procedures when appropriately indicated.