case_images: PMC11738960_01
case_images: Computed tomography angiography demonstrating inadvertent dialysis catheter insertion into the right subclavian artery (arrow), just distal to the vertebral artery (A). Digital subtraction angiography (DSA) of the left vertebral artery demonstrating adequate perfusion to the entire basilar system (B). DSA image before treatment (C). Occlusion of side branches with coils (arrowheads) to prevent type-II endoleak (D). The pull-through system constructed to advance the stent system without the support of a guiding catheter (E).
case_images: AMS2-12-e70038-g003.jpg
case_images: PMC11738960_01_AMS2-12-e70038-g003.jpg
case_images: ams270038-fig-0001
case_images: Contrast-enhanced computed tomography revealed inadvertent catheter insertion into the SA, just distal to the vertebral artery (VA) bifurcation (Figure 1A). Selective angiography of the left VA visualized the entire vertebrobasilar system (Figure 1B), indicating tolerance to right VA occlusion. Side branches from the SA were coil embolized to prevent type-II endoleak (Figure 1D). A 0.035 inch x 300 cm wire was passed to the brachial artery to complete the pull-through (Figure 1E).
case_images: One-third stent deployment (dotted line) and positioning of a touch-up balloon distal to the stent (arrowhead pointing to the balloon tip) with the pull-through wire (A). Full deployment of the covered stent (dashed line) following catheter removal (B). Swift advancement and inflation of the balloon to secure the tear (C). The final angiography (D) and the follow-up computed tomography angiography (E) confirm successful repair.
case_images: AMS2-12-e70038-g001.jpg
case_images: PMC11738960_01_AMS2-12-e70038-g001.jpg
case_images: ams270038-fig-0002
case_images: Flagstaff, Arizona, USA) advancement along the guidewire. As a preparatory step, after systemic heparinization, the distal one-third of the VIABAHN was deployed, with a touch-up balloon (Mustang 10 x 40 mm; Boston Scientific, Marlborough, Massachusetts, USA) positioned just distal to the covered stent (Figure 2A). For the main step of vessel sealing, the following procedure was performed sequentially: Immediately after the dialysis catheter extraction, the remaining two-thirds of the covered stent was fully deployed and the stent system was withdrawn to the brachiocephalic artery (Figure 2B), followed by swift balloon advancement to the injury site and inflation (Figure 2C).