Endovascular Management of Iatrogenic Vertebral Artery Pseudoaneurysm: A Case Report

Abstract

Iatrogenic injury of the vertebral artery during cervical spine surgery though uncommon is critical. With advances in interventional endovascular techniques, the therapeutic approach for vertebral artery injuries has changed. Nonetheless, an established strategy for their management is lacking. We report a case of pseudoaneurysm due to vertebral artery injury, during cervical spine surgery for a tumor, that was treated successfully with endovascular coiling in a plug-and-patch fashion after triple stenting failed.

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

“…The majority of the presented cases report favorable outcomes following endovascular intervention. As seen in Park et al [22] and Gigliotti et al [24], there were no thromboembolic complications post-intervention. Such outcomes emphasize the safety and efficacy of these techniques, especially when employed promptly and with precision.…”

“…Dual antiplatelet therapy after endovascular treatment appears to be a consistent recommendation to prevent thromboembolic complications [22]. Furthermore, the choice of specific antiplatelet agents, such as ticagrelor as reported by Gigliotti et al [24], can offer benefits in minimizing risks of hemorrhage while preventing thromboembolic complications.…”

“…They have been managed with the placement of an endovascular stent as in the present case. However, there is also the option of management with the placement of coils or their combined use [22]. There is also the possibility of management through endovascular embolization.…”

“…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).…”

“…Complications have been reported to range between 12-30%, including lesions of the vertebral artery, for which an analysis of preoperative imaging studies should be performed, taking into account anatomical variants of the artery, dominant vertebral artery, and/or hypoplastic, tortuous, pronounced loops, etc. [22,[43][44][45][46]. Winegar et al [47] have done a literature search including 34 studies and 799 adult patients.…”