Neurocritical care
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Case Reports
Endovascular treatment of inadvertent cannulation of the vertebro-subclavian arterial junction.
Inadvertent arterial cannulation at a noncompressible site is a highly risky complication of central venous line placement. ⋯ Due to the complex site of cannulation, and the patient being fully anticoagulated, the use of a percutaneous closure device was not attempted. Open vascular surgery was not a treatment option due to high surgical risk. After determining left VA dominance, the right VA was occluded distal to the catheter entry point with platinum coils. Subsequently, a covered stent was placed into the SCA across the origin of the VA. The sheath was then removed safely without complications. A minor leak was initially present, which was stopped by repeating balloon inflation within the stent above nominal pressure.
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Subarachnoid hemorrhages caused by intracranial dissections are rare. The management of dissections in these cases not clear. ⋯ Basilar artery dissection can present with subarachnoid hemorrhage. No guidelines are available for management of basilar artery dissections and treatment should be tailored to the individual patient.