Rotational vertebral artery occlusion secondary to completely extraosseous vertebral artery Rachel Rendon, BS, Kristyn Mannoia, MD, Steven Reiman, MD,

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Rotational vertebral artery occlusion secondary to completely extraosseous vertebral artery Rachel Rendon, BS, Kristyn Mannoia, MD, Steven Reiman, MD, Louise Hitchman, MBBS, BSc, William Shutze, MD Journal of Vascular Surgery Cases and Innovative Techniques Volume 5, Issue 1, Pages 14-17 (March 2019) DOI: 10.1016/j.jvscit.2018.09.006 Copyright © 2018 The Authors Terms and Conditions

Fig 1 Preoperative computed tomography angiography (CTA) demonstrates extrinsic compression of the extraosseous V2 segment of the right vertebral artery (VA). The yellow arrow points to the posterior superior projection of the thyroid cartilage. The green arrow demonstrates extrinsic compression of the right VA by the posterior superior projection of the thyroid cartilage. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, 14-17DOI: (10.1016/j.jvscit.2018.09.006) Copyright © 2018 The Authors Terms and Conditions

Fig 2 The yellow arrow points to the extraosseous right vertebral artery (VA) and the green arrow shows the levator scapulae muscle coursing anterior to and compressing the VA. The black arrow points to the posterior carotid sheath being retracted with stay sutures. The patient's head is in a neutral position. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, 14-17DOI: (10.1016/j.jvscit.2018.09.006) Copyright © 2018 The Authors Terms and Conditions

Fig 3 The extraosseous V2 segment of the right vertebral artery (VA) is demonstrated by the yellow arrow. The green arrow points to the posterior superior projection of the right thyroid cartilage. The area of extrinsic compression of the right VA is circled in white. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, 14-17DOI: (10.1016/j.jvscit.2018.09.006) Copyright © 2018 The Authors Terms and Conditions

Fig 4 Comparison of the preoperative (A) and postoperative (B) volume rendered computed tomography angiograms of the vertebral artery (VA; arrows) demonstrates that segmental removal of the thyroid cartilage has resolved the rotationally induced compression. Journal of Vascular Surgery Cases and Innovative Techniques 2019 5, 14-17DOI: (10.1016/j.jvscit.2018.09.006) Copyright © 2018 The Authors Terms and Conditions