Endovascular Vertebral Artery Transposition using Flow Reversal Technique for Left Subclavian Artery Stump Syndrome

Abstract Background Cerebellar strokes are a rare complication related to thoracic endovascular aortic repair (TEVAR). This can manifest in an indolent manner or as a neurological catastrophe. Often it is unclear when a surgical intervention is needed. Patients at risk for this relatively rare complication are not easily identified. Case We describe an endovascular option with flow reversal for left vertebral artery transposition using stent grafts in order to relocate arterial inflow and exclude a floating thrombus at the proximal subclavian artery (SCA) related to a previous TEVAR. Conclusion Ligation of the subclavian artery proximal to the vertebral artery should be considered when performing carotid subclavian bypass for elective TEVAR. This case details a unique, less invasive approach for vertebral artery transposition and thrombus exclusion in a high risk patient with previous neck dissection.