In Order to Arrive from A to B you Need to Use Access Roads – Accessing Posterior Cerebral Circulation through Thyrocervical Trunk

A female patient was admitted because of a sudden headache followed by loss of consciousness. On emergent CT scan, subarachnoid hemorrhage with intraventricular extension was observed due to a ruptured basilar artery aneurysm. On DSA, a dilated thyrocervical trunk and its anastomosis to the V3 segment of the vertebral artery were observed on the right side. A right transradial approach was used to enter the thyrocervical ostium. A distal access catheter was placed in the ostium, through which a microcatheter was introduced. Finally, the V3 segment of the vertebral artery was reached. The ruptured basilar aneurysm was occluded using coils with careful selection of coils due to its wide neck. Follow-up DSA showed enlargement of an anterior communicating artery aneurysm. Aneurysm was occluded using an intrasaccular device. VAS can pose significant difficulties when approaching the posterior cerebral circulation by endovascular means. Fluoroscopy-guided direct percutaneous vertebral arteries puncture distal to the occlusion point and hybrid approaches have been used in VAS. A technique similar to ours was used only once as reported in the literature, but without follow-up. In patients with sufficiently developed collateral circulation, collaterals could be used as an endovascular route for treatment of distally located lesions.