Acute Endovascular Therapy for Iatrogenic Vertebral Artery Injury: A Case Report

Abstract

Accidental puncture of the vertebral artery (VA) by central venous catheters and other devices has been reported as a rare complication. We performed endovascular therapy in the acute phase in a patient in whom a largecaliber sheath was misinserted into the VA.Case Presentation: A 68-year-old woman scheduled for open heart surgery had an 8-Fr. sheath inserted through the right internal jugular vein (IJV). This sheath penetrated the IJV and was misplaced in the V1 segment of the right VA.Endovascular therapy was performed. First, a 9-Fr. balloon-guiding catheter (BGC) was inserted and a 0.035-inch guidewire was pulled through it and the 8-Fr. sheath misinserted into the right VA. A 6-Fr. guiding catheter was inserted into the left VA and the microcatheter reached distal of where the sheath was inserted via the basilarunion. Then, the same area was embolized with coils to block retrograde blood flow. The BGC was then guided to the right VA origin using a pull-through wire while the 8-Fr. sheath was carefully withdrawn. The sheath was pulled back until just before exiting the VA and additional coils were placed via a microcatheter inserted into the BGC to occlude the right VA. Postoperatively, the patient had no neurological findings. Conclusion:We reported a rare case of iatrogenic VA injury. Attention to hemorrhage and intracranial blood flow resulted in a favorable outcome.

Multiple Myeloma Treatment Challenges: A Case Report of Vertebral Artery Pseudoaneurysm Complicating Occipitocervical Arthrodesis and a Review of the Literature

“…After the first screening, 48 articles were selected and 425 were excluded. In the last screened series of articles, 11 were selected [15,[19][20][21][22][23][24][25][26][27][28]. Each of these 11 carefully assessed articles successfully met the predetermined inclusion criteria and was therefore integrated into the review, as delineated in (Tables 1-2).…”