Structural Restoration of an Unruptured Vertebral Artery Dissection Following Autologous Mesenchymal Stem Cell Therapy: A Case Report

ABSTRACT

Vertebral artery dissection (VAD) is a recognized cause of ischemic stroke, and current management relies on antithrombotic therapy that is not specifically directed at structural repair of the arterial wall. We report a man in his mid‐50s who presented with a sudden, severe right occipital headache after a golf swing and had a history of a contralateral left VAD 16 years earlier. High‐resolution vessel wall magnetic resonance imaging and angiography showed an acute, unruptured dissection of the right V4 segment with an intramural hematoma, and serial imaging documented progression of the true‐lumen stenosis before treatment. Because the lesion was progressing and stenting of the intracranial V4 segment carried a high risk of iatrogenic rupture, autologous bone marrow–derived mesenchymal stem cells (MSCs) were administered as a well‐tolerated adjunct to continued antithrombotic therapy, in two systemic infusions at 8 weeks and 10 months after onset. The patient had an uneventful clinical course with no infusion‐related adverse events, and follow‐up imaging at 11 months showed resorption of the intramural hematoma and restoration of a normal‐appearing lumen and wall. Because spontaneous healing of unruptured VAD cannot be excluded, this single, uncontrolled observation cannot establish that MSC therapy caused the recovery; nonetheless, the treatment was well‐tolerated and the favorable course warrants evaluation in adequately controlled studies before any therapeutic role of MSCs in VAD can be defined.