Emboligenic ulcerated plaque of the foramen of the vertebral artery

Atheromatous plaques of the vertebral artery ostium are usually smooth and cause hemodynamic ischemia in the vertebro-basilar territory only when stenosis is severe. A case of crescendo vertebro-basilar attacks is reported and related to an ulcerated plaque of the vertebral artery ostium. The patient underwent surgical endarterectomy after failure of an antiplatelet treatment. He has remained asymptomatic for six months. Diagnosis of vertebral artery ulceration is difficult by ultrasonics or digitalized arteriography because of the small diameter of the vessel and its posterior origin. The frequency of ulcerated plaques of the subclavio-vertebral intersection is probably underestimated in the literature Labauge et al. (1987) emphasized recently the risk of cerebellar infarction during the natural history of vertebral artery occlusion. Crescendo vertebro-basilar transient ischemic attacks can be caused by a plaque rupture of of the vertebral ostium which leads secondarily to vertebral artery occlusion. Therapeutic options for atheromatous lesions of the posterior circulation are not clearly defined by controlled studies. In the reported case and in series reported in the literature, surgery would appear to be an efficient procedure with low mortality and morbidity.