Extensive bilateral vertebral artery remodeling following treatment of dissection using pipeline embolic device

Background—Cerebral artery dissection remains a significant cause of stroke, and the mainstay of treatment has been medical management with anticoagulation, although flow-diverting stents have been used in some cases of arterial dissection resistant to medical management. Methods—We present a case report of bilateral vertebral artery stenting using pipeline embolic device flow-diverting stents, after failed medical management of the dissection. Results—This case demonstrated substantial subsequent vertebral arterial remodeling and good clinical outcome with maintenance of posterior circulation. The patient did not suffer any further strokes or posterior circulation symptoms following vertebral artery remodeling. Conclusion—In cases where traditional management of arterial dissection has not been efficacious, flowdiverting stents may be useful in treating dissections of the posterior cerebral circulation, even with bilateral involvement.