C89 Endovascular therapy of ruptured subclavian-steal flow-related, fusiform vertebrobasilar junction aneurysm

<h3>Introduction</h3> Occlusion of the subclavian artery (ScA) proximal to the origin of the vertebral artery (VA) may cause subclavian-steal phenomon or syndrome. Flow reversion in the ipsilateral VA inherits the potential of sequelae, like formation of subclavian-steal flow-related aneurysms of the ipsilateral vertebrobasilar junction (VBJ), a rare entity. When unruptured, restoration of antegrade flow in the ScA bears the chance of aneurysm shrinkage, but in case of subarachnoid hemorrhage (SAH), the therapeutic approach must include not only recanalization of the ScA but also directly address the ruptured aneurysm. <h3>Case Description</h3> 73 year old female with subrarachnoid hemorrhage WFNS grade II, Fischer grade 4. CTA revealed a fusiform aneurysma of the right VBJ, with chronic occlusion of the ipsilateral ScA. Subclavian-steal and the associated VBJ-aneurysm have been unknown and asymptomatic until the SAH. Due to the fusiform shape of the aneurysm, simple coiling and intraaneurysmatic devices were no option, and flow diverting stent was considered inappropriate as well. Endovascular recanalization of the ScA and consecutive vessesl sacrifice of the aneurysm-bearing V4-segment was reconciled. After challenging transbrachial recanalization of the elongated ScA-occlusion with balloon-mounted stents, coil-occlusion of the ipsilateral VBJ could be performed without difficulties. <h3>Conclusions</h3> Sbclavian steal flow-related VBJ aneurysms are rare, and invasive therapy of asymptomatic cases should be indicated reluctant, but ruptured cases require imperative therapy. Restoration of physiologic antegrade flow in the ScA is either mandatory, or at least beneficial for therapy, and the relieve of hemodynamic stress of the ipsilateral VBJ reduces the risk of aneurysm recurrence <h3>Conflict of Interest</h3> No