Direct ultrasound-guided puncture of vertebral artery V2 segment during mechanical thrombectomy

BMJ Case Rep. 2021 Jan 26;14(1):e238979. doi: 10.1136/bcr-2020-238979.


An 83-year-old man experienced left upper limb uncontrolled movements preceded by intense gasping during night rest, which progressed to unconsciousness and respiratory arrest requiring intubation. He was diagnosed with acute stroke due to distal occlusion of the basilar artery and received indication for endovascular thrombectomy. Standard endovascular approach includes percutaneous puncture of the femoral or radial arteries; however, the presence of unfavourable vascular anatomies (stenotic origin and tortuosity) did not allow catheterisation of the intracranial vessels through conventional access, and based on the consistent time lapse from onset of symptoms and deterioration of the clinical condition, a direct right vertebral artery ultrasound-guided puncture was performed. After one attempt of a triaxial technique, a complete recanalisation of the basilar artery and of its distal branches was achieved. Direct percutaneous puncture of the vertebral artery represents a rescue access strategy for treatment of posterior circulation stroke when other routes are not feasible.

Keywords: interventional radiology; neuroimaging; stroke.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Cerebral Angiography
  • Computed Tomography Angiography
  • Endovascular Procedures / methods*
  • Femoral Artery
  • Humans
  • Male
  • Punctures / methods*
  • Surgery, Computer-Assisted
  • Thrombectomy / methods*
  • Ultrasonography
  • Vascular Closure Devices
  • Vertebral Artery / diagnostic imaging
  • Vertebral Artery / surgery*
  • Vertebrobasilar Insufficiency / diagnostic imaging
  • Vertebrobasilar Insufficiency / physiopathology
  • Vertebrobasilar Insufficiency / surgery*