Endovascular Repair of an Aortic Arch Aneurysm in a Patient with a Hypoplastic Left Vertebral Artery Terminating into the Posterior Inferior Cerebellar Artery

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

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Hybrid Repair of an Aortic Arch Aneurysm Using Double Parallel Grafts Perfused by Retrograde Flow in Endovascular Repair Combined With Left Subclavian Artery Surgical Bypass

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.12.089 ◽

2015 ◽

Vol 100 (5) ◽

pp. 1888-1891 ◽

Cited By ~ 3

Author(s):

Gao Feng ◽

Zeng Qian ◽

Guan Jun ◽

Lin Fangming

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Endovascular Repair ◽

Left Subclavian Artery ◽

Aortic Arch Aneurysm ◽

Retrograde Flow ◽

Hybrid Repair ◽

Surgical Bypass ◽

Arch Aneurysm

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Combined surgical and endovascular treatment of a giant vertebral artery aneurysm in a child

Journal of Neurosurgery ◽

10.3171/jns.1994.81.2.0304 ◽

1994 ◽

Vol 81 (2) ◽

pp. 304-307 ◽

Cited By ~ 20

Author(s):

Mazen H. Khayata ◽

Robert F. Spetzler ◽

Jan J. A. Mooy ◽

James M. Herman ◽

Harold L. Rekate

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Mass Effect ◽

Left Vertebral Artery ◽

Parent Artery ◽

Content Type ◽

Cerebellar Artery ◽

Coil Occlusion ◽

Surgical Bypass

✓ The case is presented of a 5-year-old child who suffered a subarachnoid hemorrhage from a giant left vertebral artery-posterior inferior cerebellar artery (PICA) aneurysm. Initial treatment consisted of surgical occlusion of the parent vertebral artery combined with a PICA-to-PICA bypass. Because of persistent filling of the aneurysm, the left PICA was occluded at its takeoff from the aneurysm. Endovascular coil occlusion of the aneurysm and the distal left vertebral artery enabled complete elimination of the aneurysm. Follow-up magnetic resonance imaging and arteriography performed 6 months postoperatively showed persistent occlusion and elimination of the mass effect. Combined surgical bypass and endovascular occlusion of the parent artery may be a useful adjunct in the management of these aneurysms.

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Anastomosis Between the Ascending Pharyngeal Artery and the Posterior Inferior Cerebellar Artery Through the Jugular Foramen

Operative Neurosurgery ◽

10.1227/neu.0000000000001098 ◽

2015 ◽

Vol 12 (2) ◽

pp. 163-167

Author(s):

Khaled Effendi ◽

Elsa Magro ◽

Jean-Christophe Gentric ◽

Tim E Darsaut ◽

Jean Raymond ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Jugular Foramen ◽

Left Vertebral Artery ◽

Cadaveric Specimen ◽

3 Dimensional ◽

Ascending Pharyngeal Artery ◽

Cerebellar Artery ◽

Direct Anastomosis ◽

Posterior Division

Abstract BACKGROUND The ascending pharyngeal artery (APA) may, in very rare cases, supply the posterior inferior cerebellar artery (PICA). In reported cases, when such is the case, the ipsilateral vertebral artery (VA) does not supply the PICA, and most of the time it is hypoplastic. OBJECTIVE To describe a unique cadaveric observation of a direct anastomosis between the posterior division (neuromeningeal) of the jugular branch of the APA and the PICA, where the PICA is also supplied by a normal-size VA. METHODS A direct connection between the APA and the PICA was examined in a cadaveric specimen using a 3-dimensional endoscope and a surgical microscope. RESULTS The enlarged jugular branch of the posterior division of the APA entered intracranially via the jugular foramen in its pars vascularis. It then connected directly with the lateral medullary segment of the PICA. The first segment of the PICA originated from a left vertebral artery of normal size and continued its normal course beyond the junction with the jugular branch of the APA. CONCLUSION Both the VA and the jugular branch of the APA may simultaneously supply the PICA territory. Recognition of this anatomic variant is relevant when planning surgical or endovascular treatments.

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