Neuro-images: "string of beads" at vertebral artery origin: 3-year angiographic follow-up after stenting for fibromuscular dysplasia.

Fibromuscular dysplasia (FMD) rarely involves the vertebral artery origin (V1 segment), a site far more commonly affected by atherosclerosis. We report an 81-year-old woman with recurrent, medically refractory dizziness, in whom angiography revealed a characteristic "string of beads" stenosis at the left vertebral artery V1 segment, with contralateral vertebral hypoplasia. A comprehensive angiographic survey excluded systemic FMD involvement. Given the symptomatic hemodynamically significant stenosis in the dominant posterior circulation supplier, a sirolimus-eluting stent was implanted, with complete symptom resolution. Three‑year imaging and five‑year clinical follow‑up demonstrated sustained stent patency with only mild intimal hyperplasia and no recurrent symptoms. This case highlights the feasibility and midterm durability of endovascular stenting for isolated vertebral artery origin FMD in carefully selected patients with refractory symptoms and critical anatomy, and provides practical guidance for managing this exceptionally rare condition.