Surgical management of extracranial vertebral artery occlusive vascular diseases. Part II: Surgical strategies

Background: Extracranial vertebral artery disease is seen in patients with internal carotid artery stenosis although the clinical significance not well understood. Methods: We analyzed data that was collected as part of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial which recruited patients with recently symptomatic internal carotid artery stenosis. We used Cox proportional hazards analysis to compare the relative risk of various endpoints between the three categories of extracranial vertebral artery disease (normal/hypoplastic, moderate/severe stenosis, and occlusion). The multivariate analyses were adjusted for age, gender, basic demographics and severity of carotid stenosis. Results: Of the 1181 subjects who had extracranial vertebral artery ultrasound evaluation, moderate to severe stenosis and occlusion of one of both extracranial vertebral arteries was diagnosed in 152(12.9%) and 57(4.8%) subjects, respectively. During the mean follow up period (±SD) of 22.1±7.1 months 102(8.6%) and 60(5.1%) experienced a stroke or died, respectively. Compared with subjects with normal or hypoplastic vertebral artery, there was a non-significant 30% higher risk of any stroke among subjects with moderate to severe vertebral artery stenosis (relative risk [RR]1.3, 95% confidence interval [CI]0.7-2.3) after adjusting for potential confounders. There was a 40% and 50% higher risk of ipsilateral stroke (RR 1.4, 95% CI0.7-2.5) and death (RR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral artery stenosis after adjusting for potential confounders. In Kaplan Meir analysis, the estimated 1 and 2 year stroke free survival for subjects with moderate to severe vertebral artery stenosis was 88% (standard error [SE]2.6%). In comparison, the estimated 1 and 2 year stroke free survival for subjects with normal or hypoplastic vertebral artery was 92.5%(SE0.8%)and 91.6%(SE0.9), respectively. Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal carotid artery stenosis with concurrent asymptomatic extracranial vertebral artery stenosis.

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Giant Pseudoaneurysm of the Extracranial Vertebral Artery Successfully Treated Using Intraoperative Balloon Catheters

Neurosurgery ◽

10.1227/00006123-199105000-00019 ◽

1991 ◽

Vol 28 (5) ◽

pp. 738-742 ◽

Cited By ~ 7

Author(s):

Junya Hanakita ◽

Hideyuki Suwa ◽

Kiyoshi Nishihara ◽

Koji Iihara ◽

Hiroshi Sakaida

Keyword(s):

Vertebral Artery ◽

Cardiac Pacemaker ◽

Innominate Artery ◽

Anatomical Location ◽

High Morbidity ◽

Vertebrobasilar System ◽

Balloon Catheters ◽

Extracranial Vertebral Artery ◽

The Right ◽

Giant Pseudoaneurysm

Abstract Traumatic pseudoaneurysms of the extracranial vertebral artery rarely occur, because of its deeply protected anatomical location. Because the direct surgical approach has resulted in high morbidity and mortality rates, ligation of the vertebral artery has been adopted, but this can cause an ischemia in the vertebrobasilar system. We report the case of a 73-year-old woman with a huge pseudoaneurysm of the right vertebral artery that occurred after attempted placement of a cardiac pacemaker. The aneurysm was 7 x 7 x 5 cm in size and its neck was situated just distal to the right subclavian artery. Direct surgical repair of the injured vessel and removal of the aneurysm were successfully performed using balloon catheters placed intraoperatively in both the innominate artery and the right vertebral artery.

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Crab Sign in Bilateral Extracranial Vertebral Artery Dissection

Journal of Clinical Neurology ◽

10.3988/jcn.2018.14.3.428 ◽

2018 ◽

Vol 14 (3) ◽

pp. 428

Author(s):

Nils Peters ◽

Stefan T Engelter

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Extracranial Vertebral Artery

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René Leriche and the development of 20th century surgery

Medicine and Pharmacy Reports ◽

10.15386/cjmed-557 ◽

2016 ◽

Vol 89 (1) ◽

pp. 176-180

Author(s):

Bogdan Ioncioaia ◽

Ioan Teodor Bud ◽

Mircea Muresan

Keyword(s):

Clinical Practice ◽

20Th Century ◽

Surgical Management ◽

Surgical Training ◽

Vascular Diseases ◽

Future Generations ◽

Bone Pathology ◽

Vascular Medicine ◽

Good Reputation ◽

French Surgeon

René Leriche (1879-1955) was a 20th century French surgeon generally known in medicine for the syndrome that carries his name, namely the Leriche syndrome in the aorto-iliac occlusive disease.This paper is published to mark the commemoration of 60 year since Leriche’s death.Although Dr. Leriche's legacy resides in the domain of vascular medicine, his research enclosed bone pathology and surgical management of pain.Having his surgical training done under professors Mathieu Jaboulay and Antonin Poncet, his friendship and association with Alexis Carrel and William Halsted have contributed to René Leriche's development as a surgeon, researcher and thinker. Following the footsteps of his mentors, he produced outstanding clinical and academic work which had earned him a good reputation among his students and colleagues. Surgeons such as Jean Kunlin, Jao Cid dos Santos, Michael DeBakey, René Fontaine and others came to study and learn from him. These future generations of surgeons would themselves bring much contribution to the understanding and treatment of vascular diseases and medicine in general.René Leriche pioneered medicine with his research and ideas. His assiduous work of teaching, research and clinical practice made his influence last to our present.

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Application of Pipeline Embolization Device for Iatrogenic Pseudoaneurysms of the Extracranial Vertebral Artery: A Case Report and Systematic Review of the Literature

Cureus ◽

10.7759/cureus.356 ◽

2015 ◽

Author(s):

Parviz Dolati ◽

Daniel G Eichberg ◽

Ajith Thomas ◽

Chris Ogilvy

Keyword(s):

Systematic Review ◽

Case Report ◽

Vertebral Artery ◽

Review Of The Literature ◽

Pipeline Embolization Device ◽

Extracranial Vertebral Artery

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Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

Case Reports in Neurological Medicine ◽

10.1155/2017/2571630 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Davide Strambo ◽

Luca Peruzzotti-Jametti ◽

Aurora Semerano ◽

Giovanna Fanelli ◽

Franco Simionato ◽

...

Keyword(s):

Blood Flow ◽

Vertebral Artery ◽

Color Doppler ◽

Artery Aneurysm ◽

Neurofibromatosis Type ◽

Distal Portion ◽

Embolic Stroke ◽

Left Vertebral Artery ◽

Stroke Recurrence ◽

Extracranial Vertebral Artery

Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1) came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

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