Stent-assisted coiling of a ruptured vertebrobasilar junction aneurysm via direct vertebral artery puncture

A 78-year-old patient was admitted with subarachnoid hemorrhage caused by rupture of a broad-based vertebrobasilar junction aneurysm. Direct endovascular access to the vertebrobasilar circulation was not possible due to chronic occlusion of the proximal dominant left vertebral artery (VA), hypoplastic right VA and posterior communicating arteries. The distal cervical left VA was reconstituted by muscular branches of the ascending cervical artery. Therefore, endovascular access was gained by direct percutaneous VA puncture guided by a roadmap-controlled anterior approach at the level of C5 proximally to the main reconstituting collateral feeders. Successful endovascular treatment of the aneurysm was performed by stent-assisted coiling. Closure of the puncture site at the cervical VA level was achieved by occluding the proximal part of the VA with coils. The post-interventional clinical course was uneventful; early post-interventional CT showed no evidence of cervical hematoma.