AbstractPosterior circulation aneurysms are difficult to treat, and if an incorporated artery is arising from the neck of aneurysm, management becomes much more challenging. Here, we are describing a novel technique used to treat a patient with a large, wide-necked left vertebral artery (VA)-posterior inferior cerebellar artery (PICA) junctional aneurysm. PICA seems to be arising from the aneurysm neck, but the aneurysm neck was not very clearly defined. So, we placed a second microcatheter into PICA, which not only allowed the coils to be placed in the aneurysm, without disrupting the flow through PICA but also helpful in assessing the aneurysmal occlusion. This technique allowed coils to be placed successfully without compromising flow through PICA.
Access techniques for mechanical thrombectomy normally include percutaneous puncture of the common femoral or, more recently, the radial artery. Although target vessel catheterization may frequently not be devoid of difficulties via both routes, the vast majority of mechanical thrombectomy (MT) cases can be successfully managed. However, in a significant minority of cases, a stable target vessel access cannot be reached resulting in futile recanalization procedures and detrimental outcomes for the patients. As such, in analogy to direct carotid puncture for anterior circulation MT, direct vertebral artery (VA) puncture (DVP) is a direct cervical approach, which can constitute the only feasible access to the posterior circulation in highly selected cases. So far, due to the rarity of DVP, only anecdotal evidence from isolated case reports is available and this approach raises concerns with regard to safety issues, feasibility, and technical realization. We present a case in which bail-out access to the posterior circulation was successfully obtained through a roadmap-guided lateral direct puncture of the V2 segment of the cervical VA and give an overview of technical nuances of published DVP approaches for posterior circulation MT.
Tumor embolization is performed before surgical excision. The Gelfoam temporarily occludes the vessels supplying the tumor by facilitating thrombus formation. We report an adverse case of Gelfoam embolization in a patient with a certain vascular anatomy. A 75-year-old man previously diagnosed with lung cancer in 2015 was admitted to Korea University Guro Hospital. He had bilateral arm paresthesia and lower extremity weakness that had progressed for 2 weeks. Cervical spine magnetic resonance imaging revealed a metastatic pathologic fracture of the C6 vertebral body and subsequent cord compression. A C6 corpectomy was scheduled, and preoperative spinal tumor embolization was planned. Angiography revealed that the left deep cervical artery (DCA) and the ipsilateral vertebral artery shared origin. Two Nester coils were positioned at the right distal DCA, one at the left DCA, and two at the left proximal DCA. Gelfoam was infused in each location. However, the patient’s mental status worsened after the left DCA embolization. A diffusion-weighted image showed diffuse cytotoxic edema in the posterior circulation without significant lesions on magnetic resonance angiography. In Gelfoam embolization, special attention is required with neurological monitoring when maneuvering DCA if it has a nearby entrance with a vertebral artery.
Spontaneous vertebral artery dissection is a rare cause of cerebellar infarction. Common presentations of cerebellar artery infarction are dizziness and ataxia. We are reporting a case of a 31-year-old male who presented with acute onset dizziness while playing badminton, who was diagnosed as cerebellar vermis infarction secondary to vertebral artery dissection.