Percutaneous transluminal angioplasty for vertebral artery stenosis due to primary central nervous system vasculitis: A case report

We report a rare case of high-grade vertebral artery stenosis caused by biopsy-proven primary central nervous system vasculitis, successfully treated with percutaneous transluminal angioplasty. Primary central nervous system vasculitis with large-vessel involvement is uncommon, and reports of effective endovascular intervention remain limited. This case is notable for 3 reasons: (1) the diagnosis was histologically confirmed, (2) standard immunosuppressive therapy failed to halt disease progression, and (3) endovascular revascularization resulted in durable recovery without complications. A 60-year-old man presented with a several-week history of progressive gait disturbance. Contrast-enhanced magnetic resonance imaging revealed a partially enhanced right cerebellar lesion, confirmed as vasculitis using brain biopsy. The patient was diagnosed with primary central nervous system vasculitis after exclusion of systemic autoimmune or inflammatory diseases. Despite high-dose corticosteroids and cyclophosphamide, cognitive decline progressed. Digital subtraction angiography demonstrated worsening left vertebral artery stenosis and hypoperfusion of the posterior circulation. Given the failure of medical therapy and progression of ischemia, endovascular intervention was pursued. Percutaneous transluminal angioplasty resulted in immediate improvement in cerebral perfusion and gradual recovery of cognitive function. During a 1-year follow-up, no recurrence or complication was observed. This case highlights the potential role of endovascular revascularization as an adjunct option for refractory large-vessel primary central nervous system vasculitis, supporting the feasibility and safety of percutaneous transluminal angioplasty when conventional medical therapy is insufficient. To our knowledge, this is among the few reported cases of successful percutaneous transluminal angioplasty for vertebral artery stenosis due to biopsy-proven primary central nervous system vasculitis.