Congenital Vertebral Artery Stenosis in Young Adult

Case at a Glance

A 26-year-old woman with congenital 75% stenosis of the right vertebral artery at C6 level, discovered incidentally during migraine workup, presenting concerns about anesthetic risk and stroke prevention.

Patient's Story

The patient is a healthy 26-year-old female, height 5'6", weight 150 pounds, non-smoker, currently taking aspirin and prenatal vitamins. She initially presented several years ago with migraines, which led to neuroimaging studies. An MRI revealed significant narrowing of her right vertebral artery at the C6 level, measuring approximately 75% stenosis. Neurological consultation determined this to be a congenital anomaly rather than acquired stenosis, as no atherosclerotic plaque was visualized. The patient was advised to consider aspirin therapy as a precautionary measure and has remained asymptomatic for two years.

Initial Assessment

MRI imaging demonstrated 75% stenosis of the right vertebral artery at C6 without evidence of atherosclerotic plaque. Neurological examination was unremarkable. The patient's young age, absence of cardiovascular risk factors, and lack of plaque formation suggested congenital etiology rather than acquired vascular disease.

The Diagnostic Journey

Initial presentation was for migraine evaluation, leading to incidental discovery of vertebral artery stenosis on MRI. Neurological consultation confirmed the likely congenital nature of the stenosis. No additional invasive testing was pursued given the patient's age, symptom profile, and imaging findings consistent with developmental anomaly.

Final Diagnosis

Congenital stenosis of right vertebral artery (75% narrowing at C6 level) without associated atherosclerotic disease.

Treatment Plan

Conservative management with low-dose aspirin therapy for potential stroke prevention. No surgical intervention indicated given congenital nature and absence of symptoms. Regular monitoring was not initially deemed necessary due to stable congenital anatomy.

Outcome and Follow-up

Patient remained asymptomatic for two years without neurological events. Recent pre-procedural assessment raised concerns about anesthetic risk, prompting questions about need for more aggressive monitoring or treatment. Medical experts consulted suggested that with intact Circle of Willis circulation and absence of plaque formation, stroke risk remains low. Recommendation for neurological re-evaluation to assess for any interval changes and to provide appropriate pre-procedural clearance. Emphasis placed on distinguishing between congenital vascular variants and acquired stenotic disease in risk stratification.