Case of the Week

AP supine plain film (A) shows a cylindrical penetrating object (arrow) passing through the right lateral pharynx. CTA of the neck (B) shows loss of flow at the distal V2 segment of the vertebral artery (arrow) at the level of C2 with short segment flow void of V3 and retrograde flow via the basilar from the contralateral vertebral artery. CTA of the neck (C) shows sparing of the right internal carotid artery. CTA of the neck (D) demonstrates an aberrant origin of the right subclavian artery (arrow) that originates as a proximal branch of the aorta passing posterior to the esophagus before passing to the right. Cerebral angiogram (E) demonstrates the right vertebral artery with no flow seen beyond this point (arrow). Cerebral angiogram (F) demonstrates embolization of the V2 segment of the right vertebral artery proximal (black arrow) to the transection and distal embolization (white arrow) by placing the catheter via the left vertebral artery via the basilar artery (red arrow) into the distal right vertebral artery distal to the segment with a flow void.