Although direct puncture of the cervical vertebral artery(VA)is not commonly performed in neuroendovascular therapy, it is sometimes inevitable for procedural or technical reasons. We report a case of a ruptured VA aneurysm that required direct cervical VA puncture for treatment. A 79-year-old man was transferred to our hospital with the diagnosis of subarachnoid hemorrhage. Cerebral angiography revealed a right VA-posterior inferior cerebellar artery aneurysm. The aneurysm showed downward projection due to retrograde flow of the right VA caused by chronic occlusion of the right subclavian artery. For endovascular treatment, the approach through the VA union via the left VA was thought to be most appropriate;however, the left VA was very tortuous and the microcatheter could not cross the VA union. We performed percutaneous direct puncture of the left cervical VA. An 18-G intravenous catheter needle(Surflo®)was advanced and set into the C5/6 segment of the VA under biplane fluoroscopic road-mapping guidance. The microcatheter reached the aneurysm and coil embolization was successfully performed. The patient was kept intubated under general anesthesia overnight, to monitor for cervical subcutaneous hematoma. Several procedures for direct VA puncture have been reported. The major problem is the difficulty with hemostasis and maintenance of the airway is important. Although the indication is limited due to the difficulty of adjunctive techniques and postoperative antithrombotic therapy, direct VA puncture under biplane fluoroscopic guidance was useful in this case.

译文

:尽管在神经内血管治疗中通常不直接进行颈椎动脉(VA)的直接穿刺,但出于手术或技术原因,有时还是不可避免的。我们报告了一例需要直接进行宫颈VA穿刺治疗的VA动脉瘤破裂的病例。一名79岁男子被转移到我院诊断为蛛网膜下腔出血。脑血管造影显示右小脑后下动脉瘤。由于右锁骨下动脉的慢性闭塞引起的右VA逆行流动,动脉瘤显示出向下的投影。对于血管内治疗,认为最合适的方法是通过左VA通过VA联合;但是,左VA曲折,微导管无法穿过VA联合。我们对左颈VA进行了经皮直接穿刺。在双平面透视镜下引导下,将18G静脉导管针(Surflo ®)推进并置于VA的C5 / 6段。微导管达到了动脉瘤,并成功进行了线圈栓塞术。病人在全身麻醉下插管过夜,以监测宫颈皮下血肿。已经报道了几种直接进行VA穿刺的方法。主要问题是止血困难,气道的维护很重要。尽管由于辅助技术和术后抗血栓治疗的困难而使适应症受到限制,但在这种情况下,在双平面荧光镜引导下直接进行VA穿刺是有用的。

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