Objectives: Traumatic vertebral artery injury (VAI) is a rare condition. We report 3 cases of VAI requiring therapeutic interventions, which were successfully treated with medical or endovascular treatments.

Case Presentations: Case 1: A 42-year-old man had a cervical vertebral fracture (the 6th cervical spine) and severe stenosis of the right vertebral artery at the same level of the cervical fracture. He was conservatively treated with antiplatelet therapy.

Case 2: A 68-year-old woman suffered from cervical fracture at the 2nd cervical spine, and vertebral artery occlusion was found at the same cervical level of the fracture. We prescribed the same therapeutic protocol as Case 1, and she was treated conservatively with antiplatelet therapy.

Case 3: A 38-year-old male had a fracture of the cervical spine (the third to sixth cervical spines). His CT disclosed the fracture with occlusion of vertebral artery. While this patient required surgical fixation for the cervical fracture, endovascular coil embolization of the left vertebral artery was performed to prevent unexpected bleeding during the spinal surgery and distal cerebral thrombosis on recanalization of the occluded vertebral artery.

Conclusion: In all the 3 cases, VAIs were diagnosed before they complicated serious neurological deficits and were adequately treated. In cases of cervical trauma, possibility of VAI had to be always considered and we should readily diagnose and adequately treat it with medical or endovascular interventions.

Objective: We report a case of internal coil trapping for a ruptured intrameatal aneurysm (AN) arising from the meatal loop of the anterior inferior cerebellar artery (AICA) .

Case Presentation: A 92-year-old female patient presenting with sudden headache, dizziness and vomiting was transferred to our department. Computed tomography (CT) showed subarachnoid hemorrhage, and digital subtraction angiography (DSA) and head 3D-CTA showed a 3.6 mm fusiform AN arising from the left AICA in the left internal auditory meatus. Considering the location of the AN, age and general condition, internal trapping with coils was performed.

Conclusion: For the intrameatal AICA AN, clipping or coil embolization may be difficult, and trapping is sometimes an option. Internal coil trapping is a feasible treatment option, but infarction in the AICA region should be considered.

Objective: We report a case of endovascular treatment for ischemic intracranial internal carotid artery dissection in a patient with COVID-19.

Case Presentation: A male in his 20s presented with a disturbance of consciousness, right hemiplegia, and aphasia. MRI showed cerebral infarction in the left cerebral hemisphere due to intracranial left internal carotid artery dissection. The patient was diagnosed with COVID-19 because of positive SARS-CoV-2 antigen on admission, and antithrombotic therapy was started in a COVID-19 dedicated bed. On the third day, the cerebral infarction progressed, and emergency intracranial stent placement was performed for internal carotid artery reconstruction.

Conclusion: Arterial dissection may be one of the complications of COVID-19 associated with endothelial dysfunction caused by SARS-CoV-2. Medical therapy is preferred in the treatment of ischemic intracranial carotid artery dissection; however, endovascular treatment is effective when symptoms worsen.

Objective: We report a rare case of ruptured basilar artery (BA) fenestration aneurysm accompanied by left persistent primitive hypoglossal artery (PPHA).

Case Presentations: A 48-year-old woman suddenly experienced a severe headache associated with vomiting. A computed tomography (CT) scan showed the presence of subarachnoid hemorrhage and mild ventricular enlargement. Three-dimensional computed tomography angiography (3D-CTA) and digital subtraction angiography (DSA) revealed ruptured BA fenestration aneurysm measuring 3.0 mm, with a 3.0-mm-wide neck and PPHA on the left side, which originated from the internal carotid artery (ICA). Because of a wide-neck aneurysm, stent-assisted coil embolization was performed. However, a rebleeding occurred after 4 hours and the outcome was poor.

Conclusion: We planned to stop the bleeding at the tip of the aneurysm by stent-assisted coiling. However, there may have been a bleeding point near the BA of the fenestration forming part. Therefore, it is necessary to consider sufficiently to evaluate the bleeding point.

Objective: We present a case of a ruptured cerebral aneurysm complicated by delayed coil protrusion into the anterior choroidal artery after coil embolization.

Case Presentation: A 49-year-old man successfully underwent coil embolization for a ruptured internal carotid artery–anterior choroidal artery aneurysm. On day 8, transient aphasia and right hemiparesis occurred, and cilostazol was added to ozagrel sodium and fasudil hydrochloride to prevent vasospasm. Neurological symptoms did not recur while these medications were administered. However, after the discontinuation of these drugs, similar symptoms reappeared on days 18 and 20. MR imaging demonstrated an acute cerebral infarction of the internal capsule’s posterior limb, and a conventional angiogram revealed coil protrusion into the anterior choroidal artery. After starting dual antiplatelet therapy, neurological symptoms did not recur. The patient was discharged with a modified Rankin Scale of 0.

Conclusion: It is important to keep in mind that coil protrusion can occur even in the subacute stage after coil embolization. Conservative treatment with antiplatelet drugs may prevent ischemic complications due to coil protrusion.

Objective: We report the case of a 15-year-old male who underwent mechanical thrombectomy due to the occlusion of the contralateral right posterior cerebral artery just after the completion of the feeder embolization for the arteriovenous malformation (AVM) using Onyx targeted for the left posterior cerebral artery.

Case Presentation: A 15-year-old male with left subcortical hematoma in the occipital lobe due to the rupture of the AVM underwent Onyx embolization. Just after the removal of the microcatheter without any entrapment, control angiography showed the occlusion of the contralateral right posterior cerebral artery. We immediately performed a mechanical thrombectomy using a stent retriever (Tron FX 2×15 mm), and complete recanalization was obtained.

Conclusion: We experienced a case of the occlusion of the contralateral posterior cerebral artery caused by the migration of Onyx during the AVM embolization. Revascularization using a stent retriever could be effective for retrieving a fragment of Onyx.

Objective: Unfavorable vascular anatomy makes thrombectomy challenging. We report a technique to overcome the challenge by using the Neuro EBU catheter and an aspiration catheter.

Case Presentations: The 8F Neuro EBU catheter with an S-shaped stiff tip is placed at the origin (at the level of aortic arch) of the target vessel. Through this catheter, an aspiration catheter is advanced into the target vessel over a 0.035-inch guidewire. Thrombectomy with contact aspiration or a combined technique with a stent retriever is carried out.

Conclusion: The technique described here is simple and useful to access the target vessel and, therefore, to achieve quicker recanalization in thrombectomy complicated with challenging aortic arch or cervical arteries.