case_images: PMC10823830_01
case_images: (A) Computed tomography (axial view) shows the fracture through the right transverse foramen at C5 (black arrow). (B) Magnetic resonance imaging sagittal images show spinal canal stenosis and intramedullary high intensity. (C) Magnetic resonance angiography shows luminal irregularity of the right VA. (D) Digital subtraction angiography (lateral view) of the right VA. There is no intimal flap, and only slight stenosis is observed at the C5 level (arrowhead). VA: Vertebral artery.
case_images: JOCR-14-63-g002.jpg
case_images: PMC10823830_01_JOCR-14-63-g002.jpg
case_images: F1
case_images: Computed tomography showed the fracture through the right TF at C5 (Fig. 1a). Magnetic resonance angiography (MRA) showed VA stenosis at the C5 level and wall irregularity distal of the stenotic lesion (Fig. 1c). Right VA angiography showed no intimal flap, with only slight stenosis at the C5 level (Fig. 1d).
case_images: (A and B) 3 days after surgery, diffusion-weighted imaging shows a dot-like high signal at the right thalamus and right posterior lobe, and magnetic resonance angiography shows that the flow of the right VA is poor. (C) 8 days after surgery, the proximal flow of the VA has shown a tendency to increase. VA: Vertebral artery.
case_images: JOCR-14-63-g003.jpg
case_images: PMC10823830_01_JOCR-14-63-g003.jpg
case_images: F2
case_images: However, at 3 and 4 days after the surgery, diffusion-weighted imaging (DWI) showed dot-like high signal at the right thalamus and right posterior lobe, and MRA showed that the right VA was almost completely occluded (Fig. 2a and b). At 8 days after surgery, the proximal flow of the right VA tended to be increased in comparison to that observed on three days after the surgery MRA, although the signal intensity of the intracranial right VA flow remained lower than that observed on MRA on admission (Fig. 2c).
case_images: (A) The right VA flow is shown on DSA (lateral view). The stenosis of the VA at the C5 level shows progression in comparison to initial DSA. (B) After coil embolization, the right VA flow is occluded. (C) White arrow shows the site of coil embolization of the VA, and black arrows indicate the titanium plates used for C4-6 laminoplasty. VA: Vertebral artery, DSA: Digital subtraction angiography.
case_images: JOCR-14-63-g004.jpg
case_images: PMC10823830_01_JOCR-14-63-g004.jpg
case_images: F3
case_images: The angiography of the right VA showed that the stenosis of the right VA at the C5 level had progressed in comparison to that observed on initial DSA (Fig. 3a). Using seven AXIUM PRIME detachable coils (Medtronic, Dublin, Ireland), we achieved complete occlusion of the right VA (Fig. 3b and c).