{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:55:30Z","timestamp":1791392130624,"version":"4.3.3"},"reference-count":15,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Interv Neuroradiol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Importance<\/jats:title>\n                    <jats:p>In patients with vertebral artery (VA) occlusion, spontaneous flow reversal may occur in the anterior spinal artery (ASA) as a source of compensatory supply to the posterior circulation. Turbulent flow and increased flux through these small arteries may predispose to luminal damage and intracranial aneurysm formation. We report a novel case of a ruptured ASA\u2013VA junction aneurysm in a patient with chronic bilateral VA occlusion, successfully treated with endovascular embolization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Presentation<\/jats:title>\n                    <jats:p>A 62-year-old female with uncontrolled hypertension presented with acute-onset headache, emesis, neck stiffness, and decreased level of consciousness. Head computed tomography demonstrated diffuse cisternal subarachnoid hemorrhage with intraventricular extension and ventriculomegaly. Computed tomography angiography showed left VA atresia and chronic right VA occlusion just distal to the posterior inferior cerebellar artery origin, as well as a complex, bilobed aneurysm at the ASA\u2013VA junction. Angiography demonstrated flow reversal from the ASA into the distal stump of the occluded right VA, which in turn filled the aneurysm. Of note, the patient's posterior circulation was predominantly supplied by the dilated ASA, and associated collaterals from ASA and right VA stump. The aneurysm was accessed and embolized using superselective microcatheterization over a soft microguidewire through the right cervical VA perforators supplying retrograde flow into and through the ASA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ASA\u2013VA aneurysms are exceedingly rare, and generally associated with atypical flow dynamics. Dynamic treatment strategies may be needed, especially in the setting of subarachnoid hemorrhage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15910199231194664","type":"journal-article","created":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T03:54:16Z","timestamp":1692330856000},"page":"1083-1087","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ruptured vertebrobasilar junction aneurysm supplied by reversed flow from the anterior spinal artery: Illustrative case report"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3920-3435","authenticated-orcid":false,"given":"Collin E","family":"Gonce","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiana Y","family":"Prather","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakeem J","family":"Shakir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyian S","family":"Jen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S","family":"Graffeo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-2-287-89787-0_6"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.15274\/INR-2014-10003"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00276-016-1764-0"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-3019(98)00114-1"},{"key":"e_1_3_2_6_2","first-page":"222","article-title":"Anterior spinal artery as a collateral channel in cases of bilateral vertebral arterial steno-occlusive diseases","volume":"28","author":"Kang HS","year":"2007","unstructured":"Kang HS, Han MH, Kim SH, et al. Anterior spinal artery as a collateral channel in cases of bilateral vertebral arterial steno-occlusive diseases. Am J Neuroradiol 2007; 28: 222\u2013225.","journal-title":"Am J Neuroradiol"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.5.FOCUS19234"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.2176\/nmc.49.354"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/1591019918758493"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2002.96.5.0837"},{"key":"e_1_3_2_11_2","first-page":"60","article-title":"MR Imaging of the anterior spinal artery in a case of bilateral vertebral arterial occlusion","volume":"35","author":"Uchiyama S","year":"1995","unstructured":"Uchiyama S, Yoshida M, Shimizu H. MR Imaging of the anterior spinal artery in a case of bilateral vertebral arterial occlusion. Rinsho Shinkeigaku 1995; 35: 60\u201363.","journal-title":"Rinsho Shinkeigaku"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000038912.88488.BD"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9260(69)80171-6"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.1.JNS182156"},{"key":"e_1_3_2_15_2","article-title":"Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage","volume":"8","author":"Lindgren A","year":"2018","unstructured":"Lindgren A, Vergouwen MD, van der Schaaf I, et al. Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2018; 8: CD003085.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67214-5"}],"container-title":["Interventional Neuroradiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15910199231194664","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15910199231194664","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15910199231194664","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:18:03Z","timestamp":1791389883000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15910199231194664"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,18]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1177\/15910199231194664"],"URL":"https:\/\/doi.org\/10.1177\/15910199231194664","relation":{},"ISSN":["1591-0199","2385-2011"],"issn-type":[{"value":"1591-0199","type":"print"},{"value":"2385-2011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,18]]}}}