Abstract 169: Using Thyrocervical Trunk Collaterals For Bailout Access of Vertebral Artery with Occluded Atherosclerotic Origin
Bibliographic record
Abstract
Introduction/Purpose Rarely, Vertebral Artery (VA) origin atherosclerotic occlusion may need to be accessed. It can be challenging if occlusion cannot be traversed anterograde. We present two cases of successful retrograde access of vertebral arteries through collaterals from ascending cervical arteries. Materials/methods Retrospective chart review of two endovascular cases from a list of retrograde access of vertebral arteries from ascending cervical arteries was performed. Results (1) A 58‐year‐old male who presented with recurrent posterior circulation embolic events in setting of left VA occlusion (failed maximal medical therapy); presented with sudden onset left‐sided weakness ataxia and facial numbness. Patient was deemed not be a thrombolytic candidate. Imaging demonstrated acute Right PCA territory stroke. Contralateral vertebral artery was non‐dominant with hypoplastic V4. Due to recurrent embolic events attributed to stump embolization from occluded left vertebral artery despite medical management, we decided to embolize left vertebral artery. Cerebral angiogram demonstrated complete occlusion of left VA with collateralization from left thyrocervical trunk. We accessed left VA from thyrocervical trunk/ascending cervical collaterals and occluded left VA below major collaterals anastomosis. Coil embolization of left VA above scattered filling defect 1.5 cm above left VA origin prevented further embolic events. (2) A 46‐year‐old male who presented with slurred speech, monocular right eye blurred vision, right facial droop and bilateral upper extremity ataxia. Post thrombolytic administration, patient failed maximal medical management. Due to recurrent posterior circulation strokes, urgent cerebral angiogram was attempted which confirmed proximal left VA and distal basilar artery occlusions, right VA terminating in PICA; retrograde filling and reconstitution of VA from central and deep cervical artery off left subclavian artery. Combined transradial and transfemoral access was acquired. Microcatheterization was attempted into thyrocervical trunk/ascending cervical branches reconstituting in left VA after which microcatheter was advanced into left VA which was advanced retrograde into left subclavian. From left transfemoral access site, Sophia catheter was used to access proximal left VA ensuring microcatheter and Sophia abut each other (image 1). Balloon angioplasty was successfully completed. This was followed by suction thrombectomy of left VA and distal basilar artery ending in stenting proximal left VA. Conclusion In patients with abnormal and challenging VA anatomy , thyrocervical trunk collaterals can serve as alternative pathways to access posterior circulation. image
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".