Treatment of iatrogenic vertebral artery injury during C1-C2 arthrodesis with a covered stent.

Iatrogenic vertebral artery injury (VAI) has been described in the context of both anterior and posterior approaches to the cervical spine.1 2 Endovascular treatment of VAI primarily entails vessel sacrifice or vascular reconstruction. The latter option offers the advantage of achieving hemostasis while maintaining parent vessel patency.3 In this video (video 1) we describe the case of a patient in their 20s undergoing C1-C2 arthrodesis with Harms technique. A V3 segment VAI was successfully treated with two overlapping covered stents which provided hemostasis and parent vessel reconstruction. Follow-up angiography demonstrated robust flow in the parent vertebral artery with no in-stent stenosis. The patient remained at neurological baseline with no ischemic or hemorrhagic complications. To our knowledge, this is the first technical video demonstrating this technique in the setting of iatrogenic VAI.neurintsurg;jnis-2024-022640v2/V1F1V1Video 1 Endovascular treatment of iatrogenic vertebral artery injury with a covered stent.