Endovascular Repair of an Aortic Arch Aneurysm in a Patient with a Hypoplastic Left Vertebral Artery Terminating into the Posterior Inferior Cerebellar Artery

Abstract

We present a 76-year-old male with an aortic arch aneurysm and a hypoplastic left vertebral artery (VA). Endovascular repair with left subclavian artery (SCA) closure was planned. The right VA was dominant, while the left VA was hypoplastic, barely connected to the basilar artery, and appeared to terminate at the posterior inferior cerebellar artery (PICA). The VA sizes and flow patterns during ultrasonography confirmed these findings. Therefore, we performed endovascular repair with left SCA reconstruction to prevent ischemia of the PICA perfusion area. After the operation, he experienced no difficulty with brain perfusion.

Cluster of variations involving vertebral, renal, and obturator arteries in a single human body- A cadaveric case report

“…Sato et al reported that the diameter of the hypoplastic left VA was 2.8 mm and the diameter of the right VA was 4.2 mm, with a difference of 1.4mm. 12 In the present case, the hypoplastic V4 segment of the right VA was 1.67mm which was narrower than the diameter of the hypoplastic VA reported by Sato et al, albeit on the right side. 12 Sarah et al compared the PICA bilaterally between the genders(n=100), by using CT angiography.…”

“…12 In the present case, the hypoplastic V4 segment of the right VA was 1.67mm which was narrower than the diameter of the hypoplastic VA reported by Sato et al, albeit on the right side. 12 Sarah et al compared the PICA bilaterally between the genders(n=100), by using CT angiography. They reported that the diameter of the right PICA ranged from 1.12 to 2.4mm and the diameter of the left PICA ranged from 1.13 to 2.37 mm.…”

“…15 Sato et al reported a hypoplastic left VA with the majority of the blood going from the left VA to the Left PICA despite the existing connections between the left VA and BA. 12 Gaskill et al reported a fenestrated left VA. 8 Rajasekhar et al reported a case of hypoplastic and duplicated V4 segment of the right VA associated with a duplicated right anterior inferior cerebellar artery. 16 It was observed that, in case of duplication of the VA, one artery usually arises from the SCA; while the other artery arises either from SCA, aorta, thyrocervical trunk, or innominate trunk; or both arteries may arise from the aorta.…”

Cluster of variations involving vertebral, renal, and obturator arteries in a single human body- a cadaveric case report.

“…In the present study, the diameter of the right VA proximal to the origin of PICA was smaller compared to the corresponding part on the left side. Sato et al reported that the diameter of the hypoplastic left VA was 2.8 mm and the diameter of the right VA was 4.2 mm, with a difference of 1.4mm [33]. In the present case, the hypoplastic V4 segment of the right VA was 1.67mm which was narrower than the diameter of the hypoplastic VA reported by Sato et al, albeit on the right side [33].…”

“…Chuang YM et al studied the MRI of 158 hemispheric ischemic stroke and 33 brainstem ischemic stroke cases and reported that the incidence of unilateral hypoplastic VA is 11.51%, with right-sided predominance [8]. Sato et al reported a hypoplastic left VA with the majority of the blood going from the left VA to the Left PICA despite the existing connections between the left VA and BA [33].…”