Vertebral Artery Disease

2015 ◽  
Author(s):  
Gregory J. Pearl ◽  
William P. Shutze
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Circulation System ◽  
Common Disease ◽  
Vertebrobasilar Insufficiency ◽  
Disease Patterns ◽  
Collateral Pathways ◽  
Artery Disease ◽  
The Right ◽  
Evaluation Patterns

Vertebral artery disease (VAD) is a significant cause of severe symptoms or stroke. Approximately 25 to 30% of strokes involve the posterior circulation system; VAD will be present in 20% of these and will be the source in about 10%. The ability to properly diagnose, manage, and treat VAD is an important skill for practitioners caring for patients with extracranial cerebral occlusive disease. This review covers anatomy, presentations of VAD, evaluation, patterns of disease, treatment, and other vertebral artery (VA) syndromes. Tables outline symptoms and differential diagnoses of vertebrobasilar insufficiency, etiologies of VA compression syndromes, posterior circulation cerebrovascular accident symptoms and associated syndromes, and ultrasonography velocity and VA stenosis. Figures show the anatomy of the VA, circle of Willis, aberrant arteries, VA compression, ischemic posterior circulation, collateral pathways to the VA, common disease patterns in VAD, VA to carotid artery anastomosis, incision for the V3 bypass, VA aneurysm, VA dissection, angiography of the right VA, giant cell arteritis, and fibromuscular dysplasia. Radiologic videos are provided. This review contains 15 figures, 6 tables, 7 videos, and 71 references.

Intracranial Vertebral Artery Disease in the New England Medical Center Posterior Circulation Registry

1997 ◽  
Vol 37 (3) ◽  
pp. 146-156 ◽  
Author(s):  
M. Müller-Küppers ◽  
K.J. Graf ◽  
M.S. Pessin ◽  
L.D. DeWitt ◽  
L.R. Caplan
Keyword(s):  
New England ◽  
Vertebral Artery ◽  
Medical Center ◽  
Posterior Circulation ◽  
Artery Disease ◽  
England Medical

scholarly journals Left Vertebral Artery to Common Carotid Artery Transposition in a Patient With Bilateral Vertebral Insufficiency: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E301-E302
Author(s):  
Sirin Gandhi ◽  
Claudio Cavallo ◽  
Justin R Mascitelli ◽  
Michael J Nanaszko ◽  
Xiaochun Zhao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Suture Technique ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Bypass Patency ◽  
Patient Consent

Abstract Extracranial vertebral artery (VA) atherosclerosis is responsible for 14% to 32% of posterior circulation infarctions.1 In the posterior circulation, narrowing of the VA > 30% is significantly associated with strokes. Subclavian artery (SCA) atherosclerosis can produce subclavian steal. Retrograde VA flow around an occluded SCA decreases blood flow to the posterior circulation and causes vertebrobasilar insufficiency (VBI). Flow augmentation to the posterior circulation can be achieved by VA endarterectomy, arterial stenting, VA-common carotid artery (CCA) transposition, or bypass using an interposition graft.2,3 This video illustrates microsurgical revascularization of the proximal VA with VA-CCA transposition. A 58-yr-old man with a prior stroke and chronic right VA occlusion presented with dysarthria and gait instability. Angiographic evaluation confirmed complete midcervical right VA occlusion and left SCA occlusion proximal to VA origin, with subclavian steal. After obtaining patient consent and a failed attempt at endovascular recanalization of the left SCA, a left VA-CCA end-to-side transposition was performed. Neck dissection exposed the left CCA. The thyrocervical trunk served as a landmark to identify the SCA, which was traced proximally to the VA origin. After proximal occlusion, the VA was transected and “fish-mouthed” for end-to-side anastomosis to CCA. An intraluminal, continuous suture technique was used to sew the back walls of this anastomosis. Postoperative computed tomography angiography confirmed bypass patency. Collateral circulation through the thyrocervical and costocervical trunks likely supplied the left arm, and no cerebral, or limb, ischemic symptoms were noted on follow-up. VA-CCA transposition is an uncommon technique for safe and effective revascularization of symptomatic, medically refractory VBI caused by VA occlusion or, as in this case, SCA occlusion with secondary subclavian steal. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Rotational vertebrobasilar insufficiency due to compression of a persistent first intersegmental vertebral artery variant: case report

2017 ◽  
Vol 26 (2) ◽  
pp. 199-202 ◽  
Author(s):  
Vivek P. Buch ◽  
Peter J. Madsen ◽  
Kerry A. Vaughan ◽  
Paul F. Koch ◽  
David K. Kung ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Dynamic Compression ◽  
Posterior Circulation ◽  
Posterior Arch ◽  
Vertebrobasilar Insufficiency ◽  
Digital Subtraction ◽  
Head Turning ◽  
Atlantoaxial Fusion ◽  
Episodic Vertigo ◽  
Hunter's Syndrome

Rotational vertebrobasilar insufficiency, or bow hunter's syndrome, is a rare cause of posterior circulation ischemia, which, following rotation of the head, results in episodic vertigo, dizziness, nystagmus, or syncope. While typically caused by dynamic occlusion of the vertebral artery in its V2 and V3 segments, the authors here describe a patient with dynamic occlusion of the vertebral artery secondary to a persistent first intersegmental artery, a rare variant course of the vertebral artery. In this case the vertebral artery coursed under rather than over the posterior arch of the C-1. This patient was also found to have incomplete development of the posterior arch of C-1, as is often seen with this variant. The patient underwent dynamic digital subtraction angiography, which demonstrated occlusion at the variant vertebral artery with head turning. He was then taken for decompression of the vertebral artery through removal of the incomplete arch of C-1 that was causing the dynamic compression. After surgery the patient had a complete resolution of symptoms. In this report, the authors present the details of this case, describe the anatomical variants involved, and provide a discussion regarding the need for atlantoaxial fusion in these patients.

SUCCESSFUL STENTING BY COMBINATION TECHNIQUE OF REVERSE FLOW AND DOWNSTREAM FILTERING FOR LONG CHRONIC TOTAL OCCLUSION OF THE CERVICAL VERTEBRAL ARTERY

Neurosurgery ◽  
2009 ◽  
Vol 65 (2) ◽  
pp. E378-E379 ◽  
Author(s):  
Tomonori Iwata ◽  
Takahisa Mori ◽  
Hiroyuki Tajiri ◽  
Masahito Nakazaki
Keyword(s):  
Vertebral Artery ◽  
Chronic Total Occlusion ◽  
Reverse Flow ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebrobasilar Insufficiency ◽  
Total Occlusion ◽  
Combination Technique ◽  
Left Posterior ◽  
The Right ◽  
Distal Filter

Abstract OBJECTIVE To report a case of successful recanalization using the combination technique of reverse flow and downstream filtering in chronic total occlusion of the bilateral vertebral artery (VA). Clinical Presentation A 59-year-old man had experienced attacks consisting of vertigo and/or dysarthria more than 1 year before presentation. He experienced symptoms despite the administration of antiplatelet drugs and presented to our institution. Diagnostic cerebral angiography demonstrated that the right VA was not occluded at the ostium but, rather, along its midcervical portion and that the left VA ended in the left posterior inferior cerebellar artery. Intervention Long chronic total occlusion of the right cervical VA was recanalized successfully and safely by reverse flow and downstream filtering with proximal flow blockade and a distal filter device positioned in the right brachial artery. Follow-up angiography at 1 year demonstrated no re-occlusion. The patient's symptoms disappeared after recanalization and did not recur. To our knowledge, there are no reports describing successful angioplasty and/or stenting for long chronic total occlusion of the cervical VA. CONCLUSION Stenting using the combination technique of reverse flow and downstream filtering can safely open even long chronic cervical VA occlusion and may be effective in the treatment of patients experiencing vertebrobasilar insufficiency due to bilateral chronic VA occlusion.

Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band

1982 ◽  
Vol 56 (4) ◽  
pp. 581-583 ◽  
Author(s):  
Timothy Mapstone ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebrobasilar Insufficiency ◽  
Fibrous Band ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
The Right ◽  
Band Crossing ◽  
Fine Print

✓ A case is described in which vertebral artery occlusion, caused by a fibrous band, occurred whenever the patient turned his head to the right side, resulting in vertigo and syncope whenever the head was turned to the right. Release of a fibrous band crossing the vertebral artery 2 cm from its origin relieved the patient's vertebral artery constriction and symptoms.

Rotational Vertebrobasilar Ischemia: Hemodynamic Assessment and Surgical Treatment

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Robert Goodkin ◽  
David A. Lundin ◽  
David W. Newell
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Transcranial Doppler ◽  
Posterior Circulation ◽  
Long Term Results ◽  
Vertebrobasilar Insufficiency ◽  
Head Turning ◽  
Vertebrobasilar Ischemia ◽  
Hemodynamic Assessment ◽  
Vertebral Artery Compression

Abstract OBJECTIVE: Rotational vertebrobasilar insufficiency is a severe and incapacitating condition. Proper investigation and management are essential to reestablish normal posterior circulation hemodynamics, improve symptoms, and prevent stroke. We present a series of 10 patients with rotational vertebrobasilar ischemia who were treated surgically and emphasize the importance of transcranial Doppler in the diagnosis and management of this condition. METHODS: All patients presented with symptoms of vertebrobasilar insufficiency induced by head turning. Transcranial Doppler documented a significant decrease in the posterior cerebral artery velocities during head turning that correlated with the symptoms in all patients. A dynamic cerebral angiogram was performed to demonstrate the site and extent of vertebral artery compression. RESULTS: The surgical technique performed was tailored to each individual patient on the basis of the anatomic location, pathogenesis, and mechanism of the vertebral artery compression. Five patients underwent removal of osteophytes at the level of the subaxial cervical spine, one patient had a discectomy, two patients had a decompression only at the level of C1–C2, and two patients had a decompression and fusion at the C1–C2 level. CONCLUSION: The transcranial Doppler is extremely useful to document the altered hemodynamics preoperatively and verify the return of normal posterior circulation velocities after the surgical decompression in patients with rotational vertebrobasilar ischemia. Surgical treatment is very effective, and excellent long-term results can be expected in the vast majority of patients after decompression of the vertebral artery.

A 72-Year-Old Female With Bow Hunter Syndrome: A Rare Surgical Approach to C4-5 Vertebral Artery Decompression: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E310-E310
Author(s):  
Michael J Gigliotti ◽  
Jacob Joseph ◽  
Byron Gregory Thompson ◽  
Paul Park
Keyword(s):  
Vertebral Artery ◽  
Dynamic Testing ◽  
Hunter Syndrome ◽  
Operative Intervention ◽  
Vertebrobasilar Insufficiency ◽  
Symptomatic Disease ◽  
Ct Angiogram ◽  
Preoperative Ct ◽  
The Right ◽  
Operative Neurosurgery

Abstract Bow hunter syndrome is defined as vertebrobasilar insufficiency due to mechanical occlusion of the vertebral artery during head and neck rotation. In many cases, this is due to osteophyte formation, disc herniation, cervical spondylosis, tendinous bands, or tumors. Symptomatic disease may vary from inducing transient vertigo to posterior circulation stroke. Although digital subtraction angiography is the gold standard in diagnosis, the underlying pathology in bow hunter syndrome may be detected with doppler ultrasound, computed tomography (CT) angiogram, magnetic resonance imaging and angiogram, and diagnostic angiography with dynamic testing. In this case, a 72-yr-old female with a recent right-sided cerebellar stroke underwent operative intervention to decompress the right vertebral artery at C4-C5 in order to relieve symptomatic bow hunter syndrome. Preoperative CT angiogram revealed bilateral significant stenosis of the vertebral arteries at the C4-C5 level with follow-up diagnostic angiogram revealing complete occlusion of the right vertebral artery with the head rotated right (compared to 80% occlusion observed when the patient's head was rotated left). Prior to the procedure, the patient experienced lightheadedness, diaphoresis, dizziness, and a sensation of facial flushing exacerbated by rotating her head to the right. To relieve her symptoms, operative intervention was undertaken. To access the lateral osteophytes originating from the uncovertebral joint, a C4-5 discectomy is utilized. The vertebral artery was decompressed, and a standard anterior cervical fusion was performed. Postoperatively, the patient was stable and was discharged 1 d after surgery. Postoperative imaging showed adequate decompression of the right vertebral artery at the level of C4-5.  The authors confirm that they have obtained, prior to submission, a written release from the patient authorizing use of this surgical video to be submitted and published in the journal Operative Neurosurgery, as well as consent to perform the procedure.

Posterior circulation stroke due to vertebral artery disease in the Chinese population

2021 ◽  
pp. 174749302110528
Author(s):  
Changqing Zhang ◽  
Zixiao Li ◽  
Liping Liu ◽  
Yuehua Pu ◽  
Xinying Zou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vertebral Artery ◽  
Chinese Population ◽  
Cox Regression ◽  
Posterior Circulation ◽  
Posterior Circulation Stroke ◽  
Cerebrovascular Events ◽  
Different Types ◽  
Extracranial Vertebral Artery ◽  
Artery Disease

Background and purpose Little is known about the distribution of the arteries responsible for noncardiogenic posterior circulation stroke due to vertebral artery disease in the Chinese population. Furthermore, few studies have compared the risk factors, imaging manifestations, and outcomes across different types of vertebral artery disease. Therefore, our aim was to compare the differences in the risk factors, imaging manifestations, and outcome across various types of vertebral artery disease. Methods We prospectively enrolled 228 patients from 22 Chinese centers with noncardiogenic posterior circulation stroke due to vertebral artery disease. Vertebral artery disease was classified by the involved segments of the responsible vertebral artery, and basilar artery (BA) involvement or not. Risk factors, clinical-radiologic patterns, and outcomes were compared across different types of vertebral artery disease. Results The intracranial vertebral artery (ICVA) was more frequently involved than was the extracranial vertebral artery (ECVA). The ICVA/ICVA + ECVA group more often presented with hypertension and higher systolic blood pressure than did the ECVA group. Compared with the single-segment-of-vertebral-artery group (SSVA), the group with multiple-segments-of-vertebral-artery (MSVA) involvement or SSVA with BA involvement had more serious clinical-radiologic patterns and worse outcomes. Multivariable Cox regression identified MSVA/SSVA + BA involvement as an independent predictor of recurrent ischemic cerebrovascular events. Conclusions The risk factors for ICVA/ICVA + ECVA were different from those of ECVA, and the MSVA/SSVA + BA group had more serious clinical-radiologic patterns and worse outcomes.

scholarly journals Rare cause of Bow Hunter’s syndrome due to an aberrant course of a vertebral artery

2019 ◽  
Vol 12 (7) ◽  
pp. e229584
Author(s):  
Kaishin Tanaka ◽  
Brendan Steinfort
Keyword(s):  
Vertebral Artery ◽  
Male Patient ◽  
Cervical Vertebrae ◽  
Distal Portion ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Rare Entity ◽  
Hunter's Syndrome

Bow Hunter’s syndrome (BHS) is a rare cause of vertebrobasilar insufficiency and is reported to most commonly be caused by vertebral artery impingement on cervical vertebrae osteophytes. We report a case in a 56-year-old male patient who on investigation of recurrent posterior circulation ischaemic strokes was found to have BHS. The aetiology of the syndrome in this patient is due to a particularly unusual aberrancy in the path of the atlantoaxial portion of the culprit left vertebral artery. Aberrancy of the distal portion of the vertebral artery is in itself a rare entity, and there are few reports of it in relation to BHS. The patient in this case was successfully treated with endovascular sacrifice of the vertebral artery with no further dynamic occlusive symptoms.

scholarly journals Dimensions and Anatomical Variants of the Foramen Transversarium of Typical Cervical Vertebrae

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Santosh Kaur Sangari ◽  
Paul-Michel Dossous ◽  
Thomas Heineman ◽  
Estomih Phillip Mtui
Keyword(s):  
Vertebral Artery ◽  
Thrombus Formation ◽  
Cervical Vertebrae ◽  
Uncinate Process ◽  
Vertebrobasilar Insufficiency ◽  
Transverse Foramen ◽  
Medial Margin ◽  
Significant Difference ◽  
The Mean ◽  
The Right

The study was conducted on random sample of seventy-one dried, typical cervical vertebrae (C3–C6). The data on the age, sex, and built was not available. Using vernier calipers with 0.01 mm accuracy, the anteroposterior and transverse diameters of transverse foramina and their distance from the medial margin of the uncinate process were measured bilaterally. The mean diameter of the right/left transverse foramen varied from 2.54 mm to 7.79 mm (mean = 5.55 ± 0.87 mm) and from 2.65 mm to 7.35 mm (mean = 5.48 ± 0.77 mm), respectively. The transverse foramen was less than 3.5 mm in three vertebrae on the right and two on the left. The osteocytes observed in 21.3% of specimens and the narrow transverse foramen may place patients at risk for vertebrobasilar insufficiency or thrombus formation. The mean distance of the transverse foramen from the medial margin of uncinate process is an important landmark to avoid vertebral artery laceration and was 5.0 ± 0.87 mm (range: 3.5–7.9 mm) on the right and 5.0 ± 1.0 mm (range: 3.2–7.7 mm) on the left side. No statistically significant difference was observed between the right and left sides. The accessory transverse foramina seen in 24% of vertebrae suggest duplications or fenestrations in the vertebral artery.

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