Stent-Assisted Coiling of Pseudoaneurysm After Vertebro-Carotid Transposition: Harmonious Combination of Open and Endovascular Neurosurgical Techniques

Most cases of vertebral artery stenosis are treated either conservatively or surgically. When non-conservative treatment is chosen, whether to treat it with open surgery or endovascular intervention remains a topic of divergence. In the setting of endovascular therapy failure, the vertebral to commo...

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Bibliographic Details
Published in:World neurosurgery 2019-07, Vol.127, p.387-390
Main Authors: Monteiro, Andre, Agnoletto, Guilherme Jose, Granja, Manuel F., Andrade, Manuella R., Hanel, Ricardo A.
Format: Article
Language:English
Subjects:
Aged, 80 and over
Aneurysm, False - diagnostic imaging
Aneurysm, False - surgery
Carotid Arteries - abnormalities
Carotid Arteries - diagnostic imaging
Carotid Arteries - surgery
Combined Modality Therapy - methods
Endovascular Procedures - methods
Endovascular therapy
Follow-Up Studies
Humans
Male
Neurosurgical Procedures - methods
Pseudoaneurysm
Stents
Vertebral Artery - abnormalities
Vertebral Artery - diagnostic imaging
Vertebral Artery - surgery
Vertebral artery stenosis
Vertebral artery stenting
Vertebral artery transposition
Vertebro-carotid transposition
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Summary:Most cases of vertebral artery stenosis are treated either conservatively or surgically. When non-conservative treatment is chosen, whether to treat it with open surgery or endovascular intervention remains a topic of divergence. In the setting of endovascular therapy failure, the vertebral to common carotid artery transposition certainly is an appropriate choice to recover the posterior circulation. Like any other open surgery, it is not devoid of soft-tissue–related complications. A pseudoaneurysm following this procedure and at this particular location is a rare but lethal complication and, to the best of our knowledge, has not yet been reported. We present the case of an 80-year-old man with previous ischemic stroke who presented to the emergency department with aphasia, right-sided weakness, and dysarthria. Invasive imaging revealed right vertebral stenosis and hypoplastic left vertebral artery that failed endovascular therapy. The patient was then treated with a right vertebral to common carotid artery transposition. During follow-up, a pseudoaneurysm was found and treated with a stent-assisted coiling. Pseudoaneurysms at the extracranial carotid and vertebral circulation are rare and have potential for deadly outcomes. Despite several treatments available, this anatomical location requires endovascular therapy due to efficacy and promptitude of this treatment. This is an interesting case where the patient's management required open and endovascular procedures. The pseudoaneurysm was a rare complication that, to the best of our knowledge, has not previously been reported. This case is an illustration of complementary work between open surgery and endovascular intervention.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2019.04.114