Prevalence of High-Riding Vertebral Artery: A Meta-Analysis of the Anatomical Variant Affecting Choice of Craniocervical Fusion Method and Its Outcome

Background and Objectives.The accessory head of the flexor pollicis longus muscle (AHFPL), also known as the Gantzer’s muscle, was first described in 1813. The prevalence rates of an AHFPL significantly vary between studies, and no consensus has been reached on the numerous variations reported in its origin, innervation, and relationships to the Anterior Interosseous Nerve (AIN) and the Median Nerve (MN). The aim of our study was to determine the true prevalence of AHFPL and to study its associated anatomical characteristics.Methods.A search of the major electronic databases PubMed, EMBASE, Scopus, ScienceDirect, and Web of Science was performed to identify all articles reporting data on the prevalence of AHPFL in the population. No date or language restriction was set. Additionally, an extensive search of the references of all relevant articles was performed. Data on the prevalence of the AHFPL in upper limbs and its anatomical characteristics and relationships including origin, insertion, innervation, and position was extracted and pooled into a meta-analysis using MetaXL version 2.0.Results.A total of 24 cadaveric studies (n= 2,358 upper limb) were included in the meta-analysis. The pooled prevalence of an AHFPL was 44.2% (95% CI [0.347–0.540]). An AHFPL was found more commonly in men than in women (41.1% vs. 24.1%), and was slightly more prevalent on the right side than on the left side (52.8% vs. 45.2%). The most common origin of the AHFPL was from the medial epicondyle of the humerus with a pooled prevalence of 43.6% (95% CI [0.166–0.521]). In most cases, the AHFPL inserted into the flexor pollicis longus muscle (94.6%, 95% CI [0.731–1.0]) and was innervated by the AIN (97.3%, 95% CI [0.924–0.993]).Conclusion.The AHFPL should be considered as more a part of normal anatomy than an anatomical variant. The variability in its anatomical characteristics, and its potential to cause compression of the AIN and MN, must be taken into account by physicians to avoid iatrogenic injury during decompression procedures and to aid in the diagnosis and treatment of Anterior Interosseous Nerve Syndrome.

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Abstract WMP44: A Meta-Analysis of Drug Eluting Stents vs Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease

Stroke ◽

10.1161/str.44.suppl_1.awmp44 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Nakul Sheth ◽

Vikas Gupta ◽

Wenzhuan He ◽

Shariyah Gordon ◽

Charles J Prestigiacomo ◽

...

Keyword(s):

Vertebral Artery ◽

Clinical Success ◽

Meta Analysis ◽

Bare Metal Stents ◽

Drug Eluting Stents ◽

Metal Stents ◽

Bare Metal ◽

Significant Difference ◽

Drug Eluting ◽

Extracranial Vertebral Artery

A Meta-Analysis of Drug Eluting Stents vs. Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease Background: —Although a growing number of reports offer evidence for the potential of drug eluting stents (DES) in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared to bare metal stents (BMS) is uncertain due to the lack of a large prospective randomized trial. Methods: —A search strategy was used using the terms "stents," "drug-eluting stents," "atherosclerosis," "vertebral artery," and "vertebrobasilar insufficiency" through Medline. Five studies met the criteria for a comparative meta-analysis. The technical and clinical success, periprocedural complications, target vessel revascularization (TVR), rates of restenosis and recurrent symptoms and overall survival were compared between the DES and BMS groups using the Mantel-Haenszel method with fixed and random effect models. Results: —The mean pretreatment stenosis was 83.8±4.2% in the DES group (n = 156) and 80.12±2.7% in the BMS group (n = 148). There was no significant difference in the technical success (OR = 1.528, p = 0.622), clinical success (OR = 1.917, p = 0.274) and periprocedural complications (OR = 0.741, p = 0.614) between the two groups. The rates of technical success, clinical success and periprocedural complications were 98.78%, 95.77% and 1.94% for the DES group vs. 100%, 97.96% and 2.96% for the BMS group. There was no periprocedural mortality, stroke or TIA. The mean clinical and radiological follow-up times were 19.1±6.9 and 14.23±1.5 months respectively, for the DES arm and 26±7.6 and 20.5±3.3 months, respectively, for the BMS group. A 0.388 odds ratio of no-restenosis in the BMS to DES arms (p = 0.001) indicated a significantly higher restenosis rate in the BMS group relative to the DES group (33.57% vs. 15.49%, respectively). When compared with the DES group, the BMS group had a significantly higher rate of recurrent symptoms (2.76% vs. 11.26%; OR = 3.319, p = 0.011) and TVR (4.83% vs. 19.21%; OR = 4.099, p = 0.001). There was no significant difference between overall survival (OR = 0.655, p = 0.32). Conclusion: —A lower rate of restenosis, recurrent symptoms and target vessel revascularization was noted in the DES group.

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Increased risk for posterior circulation ischaemia in patients with vertebral artery hypoplasia: A systematic review and meta-analysis

European Stroke Journal ◽

10.1177/2396987317700540 ◽

2017 ◽

Vol 2 (2) ◽

pp. 171-177

Author(s):

Aristeidis H Katsanos ◽

Sotirios Giannopoulos

Keyword(s):

Systematic Review ◽

Observational Study ◽

Vertebral Artery ◽

Risk Ratio ◽

Meta Analysis ◽

Posterior Circulation ◽

Anterior Circulation ◽

Study Protocols ◽

Increased Risk ◽

Vertebral Artery Hypoplasia

Introduction Although several study protocols reported that vertebral artery hypoplasia can predispose to posterior circulation ischaemia, the role of vertebral artery hypoplasia in the risk of posterior circulation ischaemia still remains controversial. The aim of the present meta-analysis was to investigate the association of vertebral artery hypoplasia and posterior circulation ischaemia. Patients and methods We performed a systematic review and random effects meta-analysis of all eligible observational study protocols reporting prevalence rates of vertebral artery hypoplasia in patients with anterior circulation ischaemia and posterior circulation ischaemia. Results We identified eight study protocols including a total of 3875 acute ischemic stroke patients (mean age: 64.2 years, 61.3% males) and reporting a pooled prevalence of vertebral artery hypoplasia 18.6% (95%CI: 10.8–30.0%). In the overall analysis, a significantly higher probability of vertebral artery hypoplasia presence was found in posterior circulation ischaemia patients compared to patients with anterior circulation ischaemia (risk ratio = 2.12, 95%CI: 1.60–2.82, p < 0.001). In the subsequent sensitivity analysis, vertebral artery hypoplasia was again found to be significantly more prevalent in patients with posterior circulation ischaemia compared to anterior circulation ischaemia (risk ratio = 1.81, 95%CI: 1.58–2.06, p < 0.001), with no evidence of heterogeneity (I2 = 0%, p for Cochran Q = 0.55) between included studies. Discussion The present report is a meta-analysis of retrospective observational study protocols, with all the inherent limitations of included studies. The heterogeneity on the reported rates of vertebral artery hypoplasia could be attributed to differences in population age, sex, race, imaging protocols and vertebral artery hypoplasia definition between included studies. Conclusion Our meta-analysis provides further evidence for a possible causal relationship between vertebral artery hypoplasia and cryptogenic posterior circulation ischaemia, an association which undoubtedly deserves further investigation in future prospective study protocols.

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Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects

Journal of Neurosurgery Spine ◽

10.3171/2017.1.spine161092 ◽

2017 ◽

Vol 27 (3) ◽

pp. 276-290 ◽

Cited By ~ 11

Author(s):

Przemysław A. Pękala ◽

Brandon M. Henry ◽

Jakub R. Pękala ◽

Wan Chin Hsieh ◽

Jens Vikse ◽

...

Keyword(s):

Vertebral Artery ◽

Ethnic Group ◽

Gold Standard ◽

Meta Analysis ◽

Posterior Arch ◽

Preoperative Screening ◽

Comprehensive Investigation ◽

Anatomical Features ◽

North Americans ◽

Pooled Prevalence

OBJECTIVEThe foramen arcuale (FA) is a bony bridge located over the vertebral artery on the posterior arch of the atlas. The presence of an FA can pose a risk during neurosurgery by providing a false impression of a broader posterior arch. The aim of this study was to provide the most comprehensive investigation on the prevalence of the FA and its clinically important anatomical features.METHODSMajor electronic databases were searched to identify all studies that reported relevant data on the FA and the data were pooled into a meta-analysis.RESULTSA total of 127 studies (involving 55,985 subjects) were included. The overall pooled prevalence of a complete FA was 9.1% (95% CI 8.2%–10.1%) versus an incomplete FA, which was 13.6% (95% CI 11.2%–16.2%). The complete FA was found to be most prevalent in North Americans (11.3%) and Europeans (11.2%), and least prevalent among Asians (7.5%). In males (10.4%) the complete FA was more common than in females (7.3%) but an incomplete FA was more commonly seen in females (18.5%) than in males (16.7%). In the presence of a complete FA, a contralateral FA (complete or incomplete) was found in 53.1% of cases.CONCLUSIONSSurgeons should consider the risk for the presence of an FA prior to procedures on the atlas in each patient according to sex and ethnic group. We suggest preoperative screening with computerized tomography as the gold standard for detecting the presence of an FA.

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Aortic arch variant with a common origin of the innominate and left carotid artery as a determinant of thoracic aortic disease: a systematic review and meta-analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz277 ◽

2019 ◽

Cited By ~ 2

Author(s):

Massimiliano M Marrocco-Trischitta ◽

Moad Alaidroos ◽

Rodrigo M Romarowski ◽

Valentina Milani ◽

Federico Ambrogi ◽

...

Keyword(s):

Carotid Artery ◽

Meta Analysis ◽

Image Interpretation ◽

Case Series ◽

Aortic Disease ◽

Common Origin ◽

Left Carotid Artery ◽

Thoracic Aortic Disease ◽

Anatomical Variant ◽

Increased Risk

Abstract The aim of this study was to investigate whether the ‘bovine’ arch [i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)] is associated with an increased risk of thoracic aortic disease (TAD). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, EMBASE and Cochrane databases were searched to identify all case series reporting about CILCA arch and TAD between January 2008 and December 2018. A total of 485 studies were screened. The prevalence of CILCA arch was assessed, and data analysis was performed considering the difference in the risk of TAD for presence versus absence of CILCA arch. Eight studies enrolling 11 381 subjects were retrieved for quantitative analysis. The proportion of TAD among CILCA arch patients was higher [41.5% (28.1–56.4)] than the proportion among patients with standard arch configuration 34.0% (20.1–51.4). The odds ratio of developing TAD was 1.4 times higher in subjects with CILCA arch (95% confidence interval 1.068–1.839). The test for an overall effect indicated a significant association between CILCA arch and TAD (P < 0.015). The I2 was 78.1% with a value of P < 0.001 for heterogeneity. The Egger test did not show evidence of publication bias (P = 0.317). In conclusion, our meta-analysis supports the hypothesis of a correlation between the presence of CILCA arch and the onset of TAD. Our results warrant a specific and long-term surveillance for patients with this anatomical variant, and a thorough awareness of its potential clinical implications during image interpretation.

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The diagnostic accuracy of magnetic resonance angiography for blunt vertebral artery injury detection in trauma patients: A systematic review and meta-analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2017.07.005 ◽

2017 ◽

Vol 160 ◽

pp. 152-163 ◽

Cited By ~ 1

Author(s):

Georgios P. Karagiorgas ◽

Alexandros G. Brotis ◽

Theofanis Giannis ◽

Christos D. Rountas ◽

Katerina G. Vassiou ◽

...

Keyword(s):

Systematic Review ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Diagnostic Accuracy ◽

Vertebral Artery ◽

Meta Analysis ◽

Vertebral Artery Injury ◽

Trauma Patients ◽

Artery Injury

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Drug eluting stents versus bare metal stents for the treatment of extracranial vertebral artery disease: a meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011697 ◽

2015 ◽

Vol 8 (8) ◽

pp. 770-774 ◽

Cited By ~ 11

Author(s):

Vivek H Tank ◽

Ritam Ghosh ◽

Vikas Gupta ◽

Nakul Sheth ◽

Shariyah Gordon ◽

...

Keyword(s):

Vertebral Artery ◽

Clinical Success ◽

Meta Analysis ◽

Bare Metal Stents ◽

Drug Eluting Stents ◽

Metal Stents ◽

Vertebrobasilar Insufficiency ◽

Bare Metal ◽

Drug Eluting ◽

Extracranial Vertebral Artery

BackgroundWhile a growing number of reports offer evidence for the potential of drug eluting stents (DES) in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared with bare metal stents (BMS) is uncertain due to the lack of a large prospective randomized trial.MethodsA search strategy using the terms ‘stents’, ‘drug-eluting stents’, ‘atherosclerosis’, ‘vertebral artery’, and ‘vertebrobasilar insufficiency’ was employed through Medline. Five studies met the criteria for a comparative meta-analysis. The technical/clinical success, periprocedural complications, target vessel revascularization (TVR), rates of restenosis, recurrent symptoms, and overall survival were compared.ResultsThere was no significant difference in the technical success (OR=1.528, p=0.622), clinical success (OR=1.917, p=0.274), and periprocedural complications (OR=0.741, p=0.614) between the two groups. An OR of 0.388 for no restenosis in the BMS to DES arms (p=0.001) indicated a significantly higher restenosis rate in the BMS group relative to the DES group (33.57% vs 15.49%). When compared with the DES group, the BMS group had a significantly higher rate of recurrent symptoms (2.76% vs 11.26%; OR=3.319, p=0.011) and TVR (4.83% vs 19.21%; OR=4.099, p=0.001).ConclusionsA significantly lower rate of restenosis, recurrent symptoms, and TVR was noted in the DES group compared with the BMS group.

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Oral Anticoagulant and Antiplatelet Therapy for Cervical Artery Dissection: A Meta-Analysis of Clinical Trials

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211051708 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110517

Author(s):

Sheng-Lin Ye ◽

Chuang Wang ◽

Lu-Lu Wang ◽

Tian-Ze Xu ◽

Xiao-Qiang Li ◽

...

Keyword(s):

Clinical Trials ◽

Ischemic Stroke ◽

Vertebral Artery ◽

Antiplatelet Therapy ◽

Meta Analysis ◽

Antiplatelet Agents ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Curative Effect ◽

Ischemic Attack

Carotid and vertebral artery dissections are estimated to account for ∼20% of strokes in patients under 45-years-old. This meta-analysis compared the efficacy and safety of treatment with anticoagulants versus antiplatelet agents to determine the optimal therapy. We searched 4 electronic databases for clinical trials published from January 1, 1980 to August 25, 2021 that included patients who received anticoagulant or antiplatelet therapy for carotid and/or vertebral artery dissections. The curative effect was judged by recanalization evaluated by imaging. The primary outcomes were all cause death and ischemic stroke; secondary outcomes included hemorrhage and transient ischemic attack (TIA). Patients who received only a single drug treatment were divided into antiplatelet or anticoagulant groups; all received conservative treatment without surgical intervention. For this investigation, we pooled the available studies to conduct a meta-analysis, which included 7 articles with 1126 patients. The curative effect of vascular recanalization was not significantly different between the 2 treatment groups (odds ratio [OR] = 0.913, 95% confidence interval [CI]: 0.611-1.365, P = .657); similarly, no significant differences were found regarding the primary outcomes all cause death (OR = 1.747, 95%CI: 0.202-15.079, P = .612) and ischemic stroke (OR = 2.289, 95%CI: 0.997-5.254, P = .051). Patients treated with anticoagulants were more likely to experience TIA (OR = 0.517, 95%CI: 0.252-1.060, P = .072) and hemorrhage (OR = 0.468, 95%CI: 0.210-1.042, P = .063), but the differences were not statistically significant. Overall, there were no statistically significant differences between anticoagulant therapy and antiplatelet therapy for the treatment of carotid and vertebral artery dissections.

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