• Tomonori Iwata, Takahisa Mori, Hiroyuki Tajiri, and Masahito Nakazaki.
• Department of Stroke Treatment, Shonan Kamakura General Hospital, Kamakura, Japan.
• Neurosurgery. 2009 Aug 1;65(2):E378-9; discussion E379.

ObjectiveTo report a case of successful recanalization using the combination technique of reverse flow and downstream filtering in chronic total occlusion of the bilateral vertebral artery (VA).Clinical PresentationA 59-year-old man had experienced attacks consisting of vertigo and/or dysarthria more than 1 year before presentation. He experienced symptoms despite the administration of antiplatelet drugs and presented to our institution. Diagnostic cerebral angiography demonstrated that the right VA was not occluded at the ostium but, rather, along its midcervical portion and that the left VA ended in the left posterior inferior cerebellar artery.InterventionLong chronic total occlusion of the right cervical VA was recanalized successfully and safely by reverse flow and downstream filtering with proximal flow blockade and a distal filter device positioned in the right brachial artery. Follow-up angiography at 1 year demonstrated no re-occlusion. The patient's symptoms disappeared after recanalization and did not recur. To our knowledge, there are no reports describing successful angioplasty and/or stenting for long chronic total occlusion of the cervical VA.ConclusionStenting using the combination technique of reverse flow and downstream filtering can safely open even long chronic cervical VA occlusion and may be effective in the treatment of patients experiencing vertebrobasilar insufficiency due to bilateral chronic VA occlusion.

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