Temporary subclavian steal to reduce intraprocedural embolic risk during detachable balloon occlusion of vertebrobasilar aneurysms: technical note with two case reports.
OBJECTIVE
Unintentional intracerebral embolization is a serious, ever present threat during neurointerventional procedures. We have devised a method to reduce this intraprocedural risk in vertebral artery interventions by creating a temporary subclavian steal.


RESULTS
For this technique, a temporary balloon occlusion catheter is advanced into the proximal subclavian artery via a femoral artery approach, while a second introducer catheter is passed into the target vertebral artery via an axillary artery access. The temporary occluding balloon is then inflated within the proximal subclavian artery, establishing a subclavian steal that diverts blood flow into the arm. Permanent balloon occlusion of the vertebral artery can then be accomplished without fear of intracerebral embolization. Two patients with vertebrobasilar junction aneurysms were successfully treated with detachable balloon embolization using this cerebral protection technique. The permanent occlusion balloons were easily passed through the introducer catheter without difficulty despite reversed vertebral artery flow. No complications were encountered, and the aneurysms were successfully occluded in both patients.


CONCLUSIONS
Temporary subclavian steal can be easily created to reduce the risk of cerebral embolic complications when performing interventional neuroradiological procedures in the vertebral artery.
Eckard
D A
DA
Department of Radiology, University of Kansas Medical Center, Kansas City 66160-7234, USA.
O'Boynick
P L
PL
Han
P P
PP
D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods; D001488:Basilar Artery; D004621:Embolization, Therapeutic; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D002542:Intracranial Embolism and Thrombosis / Q000517:prevention & control*; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D013348:Subclavian Artery; D013349:Subclavian Steal Syndrome; D014711:Vertebral Artery