Acute treatment of V4 aneurysm with flow diverter by retrograde approach

Authors: MAIA Carolina, VEIGA Ricardo, NUNES César, MACHADO Egídio

Discover the case of a 60-year-old female heavy smoker who presented with a sudden headache and subarachnoid hemorrhage from a V4 right vertebral artery aneurysm. Due to challenges with arterial catheterization, the medical team utilized a retrograde approach through the left radial access to perform endovascular treatment of the acute aneurysm.

• Case presentation

  Patient presentation

  • 60-year-old female patient;
  • Heavy smoker;
  • No previous medical history;
  • Presented with a sudden headache and subarachnoid hemorrhage secondary to a V4 right vertebral artery aneurysm.

   

  CASE

  

  

   

  • Patient was taken to DSA but we could not catheterize both femoral and right subclavian arteries.
  • Thoraco-abdominopelvic CTA for therapeutic planning confirmed occlusion of these arteries (arrows) with the left subclavian artery patent.

   

   

  • EV treatment of the acute aneurysm by retrograde approach through left vertebral artery by left radial access.

   

  

   

  Treatments options:

  • Stent & coils? 
  • Flow Diversion (FD)? 
  • Vertebral occlusion? 
• Intervention

  Treatment

  • Pipeline Vantage 021 3.25x20
  • Satisfying position and apposition

   

  

   

  Outcome

  • No intraprocedural complications seen;
  • Patient Recovered well and discharged after 6 days;
  • On Follow up:
    • No neurological deficits (mRS 0)
    • No cerebral infarction
    • No embolism
  • Last CTA revealed patency of FD with aneurysm exclusion and filiform right distal V4 segment.

   

  
• Learning Points
  • Complex problems sometimes require an alternative approach;
  • Radial approach provides new options to the interventionist in challenging situation;
  • Flow diversion is an attractive alternative strategy for management of acutely ruptured aneurysms.