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Case report
Ultrasound guided V3 segment vertebral artery direct percutaneous puncture for basilar artery mechanical thrombectomy in acute stroke: a technical report
  1. Jamsheed A Desai1,
  2. Mohammed A Almekhlafi1,2,
  3. Michael D Hill3,
  4. Mayank Goyal4,
  5. Muneer Eesa5
  1. 1Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Internal Medicine, King Abdulaziz University, Saudi Arabia
  3. 3Department of Clinical Neurosciences, Radiology, and Medicine, Community Health Sciences, HBI, University of Calgary, Calgary, Alberta, Canada
  4. 4Department of Clinical Neurosciences and Radiology, HBI, University of Calgary, Calgary, Alberta, Canada
  5. 5Department of Radiology, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr M Eesa, Department of Radiology, University of Calgary, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada; Muneer.Eesa{at}albertahealthservices.ca

Abstract

A middle aged patient presented with acute ischemic stroke due to basilar artery occlusion. The patient clinically deteriorated despite intravenous thrombolysis and was referred for mechanical thrombectomy. The right vertebral artery was occluded and could not be accessed despite attempting various shaped catheters, even when a radial artery access was used. The left vertebral artery ended in the posterior inferior cerebellar artery. Eventually, ultrasound guided V3 segment vertebral artery direct puncture was successfully done and the procedure was completed. No access related complications were encountered. Direct cervical arterial puncture can be safely used by experienced operators as a last resort in acute stroke cases with difficult access.

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