Endovascular Treatment of a Ruptured Aneurysm of the Right Vertebral Artery with an Aberrant Right Subclavian Artery Genki CHIKAMATSU 1,2 , Takeshi HIU 2 , Hiroaki OTSUKA 3 , Eri SHIOZAKI 1,2 , Hikaru NAKAMURA 1,2 , Ichiro KAWAHARA 2 , Tomoya MORITSUKA 2 , Tomonori ONO 2 , Wataru HARAGUCHI 2 , Ryujiro USHIJIMA 2 , Keisuke TSUTSUMI 2 1National Hospital Organization Nagasaki Medical Center 2Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center 3Department of Neurology, National Hospital Organization Nagasaki Medical Center Keyword: aberrant right subclavian artery , Kommerell's diverticulum , subarachnoid hemorrhage , vertebral artery ruptured aneurysm pp.223-229
Published Date 2020/3/10
DOI https://doi.org/10.11477/mf.1436204166
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 We report a rare case of the endovascular treatment of a ruptured aneurysm of the right vertebral artery with an aberrant right subclavian artery(ARSA).

 A 60-year-old woman was urgently admitted because of consciousness disturbance. Brain CT showed subarachnoid hemorrhage, and CT angiography showed a right vertebral ruptured aneurysm. Endovascular treatment of the aneurysm was performed via a transfemoral approach. During the endovascular treatment, the right subclavian artery was found to diverge from the descending aorta on the periphery of the left subclavian artery. An ARSA was detected, and the right vertebral artery(VA)originated from the ARSA. The guiding catheter was passed through the right VA via an ARSA, and the aneurysm was completely embolized. The patient was transferred to another hospital on day 44 without any motor weakness. To our knowledge, this is the first case of an ARSA with a ruptured aneurysm in the right VA for which endovascular treatment was successfully performed via the ARSA. In patients with an ARSA or aberrant left subclavian artery, the artery could merge with Kommerell's diverticulum(KD)at its origin and be histologically fragile. Thus, in patients with an ARSA, attention should be paid to catheterization to avoid injuring the KD. CT angiography of the aortic arch might be considered before endovascular treatment.

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