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Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances
  1. Sean Thomas O’Reilly1,
  2. Ian Rennie1,
  3. Jim McIlmoyle2 and
  4. Graham Smyth1
  1. 1 Interventional Neuroradiology, Royal Victoria Hospital, Belfast, UK
  2. 2 Stroke Medicine, Royal Victoria Hospital, Belfast, UK
  1. Correspondence to Dr Sean Thomas O’Reilly, sean.oreilly{at}


A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

  • interventional radiology
  • stroke
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  • Contributors STO’R involved in the case presented, wrote up the case report and produced the figures attached as well as the discussion. IR and GS involved in the case presented and proof read the report. JMI involved in the case presented, contacted patient for consent to publish and proof read the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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