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. 2019 May 16;10:428. doi: 10.3389/fneur.2019.00428

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Copyright © 2019 Xu, Quan, Zaidat, Chen, Wang, Yuan, Yan, Lu and Guan.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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A patient presented initially with recurrent posterior circulation territory TIAs on anti-platelet therapy, including diplopia. (A) Subtracted angiogram in the working angle demonstrated left vertebral artery occlusion and a concentric severe (75%) stenosis in the V4 segment of the right vertebral artery with the posterior inferior cerebellar artery (PICA) origin from the stenotic lesion. (B) A 0.008 inch microwire was placed in PICA aimed to protect it during the PTAS and a 0.014 inch microwire placed in P2 segment of right posterior cerebral artery (PCA) with the microwire tip manipulated a U- shaped loop inside the vessel. (C) The stenotic lesion was dilated with a 3.0 × 15-mm Gateway balloon. (D) Vertebral angiography showed significant improvement of the stenosis immediately after angioplasty. (E) Microcatheter angiography showed no vessel perforation, dissection and thrombus occurred in the distal artery where the microwire tip placed. (F) A 4.0 × 15-mm Neuroform EZ stent was deployed across the target lesion, Final angiography showed near 15% residual stenosis.