Ruptured vertebral artery dissecting aneurysm is more prone to re-bleeding and thus needs immediate surgical management. We present a case of 47 years old male with ruptured vertebral artery dissecting aneurysm which was immediately treated by endovascular surgery. Coil occlusion of the vertebral artery at the aneurysm site was performed. As emergency open surgery is often not possible, this case shows that endovascular surgery is an effective and helpful alternative.

Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications.
Arm ; Brachial Artery ; Carotid Artery, Internal ; Catheters ; Constriction, Pathologic* ; Coronary Artery Bypass* ; Endovascular Procedures ; Femoral Artery ; Humans ; Mammary Arteries ; Middle Aged ; Stents* ; Subclavian Artery* ; Subclavian Steal Syndrome* ; Transplants ; Vertebral Artery