He underwent coronary and cerebral angiography which revealed coronary artery disease (triple vessel disease) and 90% narrowing in the right vertebral artery (dominant) distally before joining basilar artery. Left vertebral artery was normal (small, non-dominant). Carotid arteries were normal bilaterally.

After discussion with the patient and his family, a decision was taken to stent the right vertebral artery.

The patient was premedicated with 325 mg. ASA , 300 mg. clopidogrel , 8000 units of UFH bolus at the start of the case . 6F Cordis sheath was inserted through right radial artery.The right vertebral artery was hooked with 6F Judkin’s right guide. After the check angiogram, the lesion was crossed with BMW guidewire. Over the guidewire, spider filter wire was exchange and the spider was deployed in the basilar artery. There was slight difficulty in negotiating the spider filter wire. Direct stenting of the lesion was done with duraflex 3.5 x 18 mm stent, deployed at 14 atm pressure. The filter wire was removed followed by an angiogram. There was good end results.The catheter and sheath were removed at the end of the case. The patient remained asymptomatic. He was discharged the following day on ASA and clopidogrel.

He remains asymtomatic (5 months follow-up completed). His episodes of dizziness, unsteadiness and visual blurring disappeared.