Abstract WMP46: Rotational Ischemic Vertebral Artery Compression (RIVAC) Syndrome Due to Cervical Facet Hypertrophy and Uncinate Process Osteophyte: Review of Seven Consecutive Cases

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Stanley H Kim ◽  
Nathan Dhablania ◽  
Joshua Kim ◽  
Rishabh Gulati ◽  
Jefferson Miley ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Uncinate Process ◽  
Surgical Decompression ◽  
Imaging Method ◽  
Endovascular Stent ◽  
Cerebral Angiogram ◽  
Endovascular Stent Placement ◽  
Vertebral Artery Compression

Introduction: The authors propose a new terminology, Rotational Ischemic Vertebral Artery Compression (RIVAC) syndrome, to describe patients who present with TIA or stroke from compression of the cervical vertebral artery (VA) below C2 by facet hypertrophy or uncinate process osteophyte associated with rotation of the head. The authors review clinical presentation, radiological findings, and management of 7 consecutive cases. Methods: Prospective analysis of 7 consecutive cases of RIVAC syndrome was performed between 2004 and 2012. We reviewed peri-operative imaging, method of treatment, and clinical and angiographic outcome. Results: A total of 6 patients (mean 66+/- 4 years) presented with stroke (N=2) or TIA including reproducible dizziness, vertigo, or syncope (N=4) associated with rotation of the head. Pre-operative dynamic cerebral angiogram showed near complete occlusion of cervical VA (N=2) or severe stenosis (60 to 80%) (N=5) during rotation of the head. The location of cervical VA compression was as follows: right C3-4 (N=1), left C4-5 (N=3), left C5-6 (N=2) and left C6-7 (N=1). Treatment included endovascular stent placement of VA without open surgery (N=1), endovascular stent placement of VA followed by partial left C5-6 factectomy 2 years later (N=1), posterior surgical decompression of VA along with bilateral facet screw fixation (N=4), and anterior cervical discectomy and fusion (N=1). Follow up dynamic cerebral angiograms and CTA angiogram of neck (6 months to 3 years) showed resolution of VA compression on rotation of head in all patients except for one who had lost in follow up. Clinical evaluation (range of 1 to 48 months) showed no recurrent stroke or TIA in all patients (mRS score of 0, N=6 and mRS of 3, N=1). Conclusion: RIVAC syndrome should be recognized as an important cause of posterior circulation TIA or stroke associated with rotation of head. Pre-operative dynamic cerebral angiogram and CT angiogram of neck are essential in localization and characterization of the level and cause of VA compression. Open surgical decompression and fixation appears to be safe and effective treatment of patients with RIVAC syndrome.

Primary conservative treatment for peritonitis-absent symptomatic isolated dissection of the superior mesenteric artery with severely compressed true lumen

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 132-141 ◽  
Author(s):  
Gang Fang ◽  
Genying Xu ◽  
Yuan Fang ◽  
Jue Yang ◽  
Tianyue Pan ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Medical Treatment ◽  
Stent Placement ◽  
Mesenteric Artery ◽  
Treatment Algorithm ◽  
Endovascular Stent ◽  
True Lumen ◽  
The Mean ◽  
Endovascular Stent Placement

Objectives The purpose of this study was to evaluate the safety and efficacy of primary conservative treatment (PCT) for peritonitis-absent symptomatic spontaneous isolated dissection of the superior mesenteric artery (S-SIDSMA) with severely compressed true lumen. Methods From January 2013 to December 2018, PCT was used in 26 cases of peritonitis-absent S-SIDSMA with severely compressed true lumen in our center based on our previous proposed treatment algorithm for S-SIDSMA. The demographics, duration from the onset to the admission, duration from the start of the conservative treatment to the alleviation of the symptoms, and in-hospital and follow-up clinical and angiographic outcomes were prospectively recorded and then analyzed. Results Among the 26 included patients, 84.6% were male. The mean age of the patients was 54.7 years. The mean duration from the onset to the admission was 3.1 days (range, 1–14 days). Symptoms in 22 patients were markedly or completely relieved during the first five-day medical treatment. Endovascular stent placement was attempted in the remaining four patients, which was successfully performed in three (75%) of them. The technical failure occurred in a patient whose compressed true lumen failed to be cannulated. Medical treatment was then continued in this patient, and his symptoms were relieved after a two-day medical treatment. During the mean follow-up period of 14.3 months, endovascular stent placement was performed in three patients due to the recurrence of the abdominal pain and the chronic intestinal ischemia. No patient showed dissection progression during the follow-up. The complete remodeling rate of the stent group was significantly higher than that of the medical group (83.3% vs. 25%, P = 0.021). Conclusions Based on our previous proposed treatment algorithm for S-SIDSMA, PCT could achieve satisfactory results both clinically and morphologically in peritonitis-absent S-SIDSMA with severely compressed true lumen.

Endovascular repair of subclavian artery aneurysms: results from a single-center experience

Perfusion ◽  
2017 ◽  
Vol 32 (8) ◽  
pp. 670-674 ◽  
Author(s):  
XiXiang Gao ◽  
LiQiang Li ◽  
YongQuan Gu ◽  
LianRui Guo ◽  
ShiJun Cui ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Treatment Outcomes ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Endovascular Repair ◽  
Stent Placement ◽  
Imaging Findings ◽  
Endovascular Stent ◽  
Endovascular Stent Placement

Objective: To present our experience of the endovascular treatment of subclavian artery aneurysms (SAAs) and analyze the clinical manifestations, imaging findings and treatment outcomes. Methods: In this retrospective study, nine patients with SAAs underwent endovascular stent placement in our center between July 2011 and June 2016. Clinical features, imaging findings, treatment outcomes and follow-up results of these SAA patients were retrospectively analyzed. Results: Nine patients were diagnosed with SAAs by computer tomography angiography (CTA). Five patients underwent percutaneous endovascular stent placement in the subclavian artery. Three patients underwent endovascular repair of the SAAs with coil embolization and stent graft. One patient underwent stent graft implantation by the simultaneous kissing stent technique. Five patients had their symptoms relieved and thrombosis occurred in one case. The mean follow-up period was 17 months, ranging from 8 to 40 months. Conclusion: For patients with SAAs, endovascular treatment is a feasible choice, with a high success rate, few complications and good clinical outcomes.

Double region of interest timing bolus technique following endovascular aortic repair: Short-term prognosis analysis

Vascular ◽  
2019 ◽  
Vol 28 (3) ◽  
pp. 233-240
Author(s):  
Nobuo Tomizawa ◽  
Shingo Ito ◽  
Tastuya Nakao ◽  
Hiroaki Arakawa ◽  
Kodai Yamamoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Stent Placement ◽  
Region Of Interest ◽  
Good Prognosis ◽  
Endovascular Stent ◽  
Kaplan Meier ◽  
Scan Speed ◽  
The Mean ◽  
Endovascular Stent Placement

Objectives To compare the incidence rate of reintervention in patients with and without complication findings at aortic computed tomography using double region of interest timing bolus (DRTB) method after endovascular stent placement of the aorta. Methods We included 40 patients who underwent computed tomography of the aorta using DRTB method after endovascular stent placement. DRTB method allows to scan the aorta with a short injection time of 9 s by synchronizing the scan speed to the aortic flow. Complication findings at computed tomography were defined as endoleak, rupture, occlusion, and infection. The primary endpoint was reintervention, which was defined as any of the following three events: conversion to open repair, graft revision, or secondary intervention. Results The mean contrast medium during computed tomography angiography was 38.6 ± 3.9 mL. Complication findings at computed tomography were present in 10 patients (25%): endoleak ( n = 9) and infection ( n = 1). During a median follow-up of 7 months (interquartile range, 4–11 months), two patients experienced reintervention. Kaplan–Meier curves by complication findings showed that event rate at 6 months was significantly higher in patients with complication findings than in patients without (20% vs 0%, p =  0.01). No patients without complication findings at computed tomography experienced reintervention. Conclusions No complication findings at computed tomography after intervention of the aorta resulted in good prognosis in patients who underwent aortic computed tomography using DRTB method.

Long-term Follow-up after Endovascular Stent Placement for Treatment of Nutcracker Syndrome

2005 ◽  
Vol 16 (3) ◽  
pp. 428-431 ◽  
Author(s):  
Soo Jin Kim ◽  
Chang Won Kim ◽  
Suk Kim ◽  
Tae Hong Lee ◽  
Jun Woo Lee ◽  
...  
Keyword(s):  
Stent Placement ◽  
Nutcracker Syndrome ◽  
Endovascular Stent ◽  
Long Term Follow Up ◽  
Endovascular Stent Placement

scholarly journals Contrast-less stent placement for vertebral artery origin stenosis

2016 ◽  
Vol 23 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Shinzo Ota ◽  
Yoshinobu Sekihara ◽  
Takahiro Himeno ◽  
Yasue Tanaka ◽  
Tatsuya Ohtonari
Keyword(s):  
Renal Function ◽  
Contrast Medium ◽  
Vertebral Artery ◽  
Intravascular Ultrasound ◽  
Male Patient ◽  
Stent Placement

We performed stent placement under intravascular ultrasound (IVUS), without the use of contrast medium, in a male patient in his 70s who had vertebral artery origin stenosis and decreased renal function. Satisfactory dilatation was achieved without complications, and the patient remained asymptomatic at 2 years of follow-up. We now report the details of this procedure. Stent placement under IVUS guidance may be useful in patients in whom contrast medium is contraindicated.

Abstract 1787: Vertebral Artery Stent Placement for Symptomatic Patients: One-Year Follow-up

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Samir N Patel ◽  
J. Stephen Jenkins ◽  
Christopher J White ◽  
Paul McMullan ◽  
J.P. Reilly ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Clinical Success ◽  
High Morbidity ◽  
Symptom Resolution ◽  
Non Invasive ◽  
Procedural Success ◽  
Repeat Angiography ◽  
One Year

Background : Symptomatic vertebral artery stenosis (VAS) has a five-year stroke risk of 30%–35%. Mortality associated with posterior circulation (PC) strokes is high, ranging from 20%–30%. Surgical revascularization is rarely performed due to high morbidity and mortality. Endovascular revascularization with stents offers a potential treatment option for these patients. Methods : One hundred nine patients (116 arteries, 70% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995–2006. Symptoms included vertigo (63%), visual changes (31%), syncope (11%), ataxia (7%), and drop attack (5%). Four patients had asymptomatic critical stenosis. Sixty-one patients (56%) had bilateral VAS, 74 patients (69%) had concomitant carotid disease, and 43 patients (39%) had a prior stroke. Procedural success was defined as residual stenosis of ≤ 20% without peri-procedural stroke or death. Clinical success was defined as procedural success with symptom resolution. Restenosis was defined as angiographic narrowing within the stent of ≥ 70% or > 50% with recurrent symptoms, or evidence of severe stenosis on non-invasive imaging (ultrasound, CT, or MR). Results : Procedural and clinical success was achieved in 108 (99.1%) and 95 (94.3%) patients, respectively. At one year, follow-up was obtained in 91 patients (83.5%), 6 patients (5.5%) had died, 5 patients (5.3%) experienced a PC stroke, and 47 patients (43.1%) underwent repeat angiography and/or non-invasive imaging. Eighty-seven of the 91 patients were initially symptomatic, 69 (79.3%) of which were symptom-free at one year. Three of those that had recurrent symptoms never achieved clinical success, 9 had developed restenosis, and 7 underwent successful re-intervention. At median follow-up of 31 months (lower and upper quartiles of 13.0 and 51.8 months), 72.5% were alive and 71.6% remained symptom-free. Conclusion : Our data demonstrates that stenting for VAS can be successfully performed in 99% of patients without peri-procedural stroke or death and is associated with durable symptom resolution in approximately 80% of patients at one year. In these high-risk patients, endovascular therapy for symptomatic VAS appears to be safe and effective at relieving symptoms.

scholarly journals An Ultrasound Model to Predict the Short-Term Effects of Endovascular Stent Placement in the Treatment of Carotid Artery Stenosis

2021 ◽  
Vol 7 ◽  
Author(s):  
Sheng-Jiang Chen ◽  
Rui-Rui Liu ◽  
Yi-Ran Shang ◽  
Yu-Juan Xie ◽  
Xiao-Han Guo ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Artery Stenosis ◽  
Endovascular Stent ◽  
Improvement Rate ◽  
Preoperative Ultrasound ◽  
Endovascular Stent Placement

Purpose: The present study aimed to explore the predictive ability of an ultrasound linear regression equation in patients undergoing endovascular stent placement (ESP) to treat carotid artery stenosis-induced ischemic stroke.Methods: Pearson's correlation coefficient of actual improvement rate (IR) and 10 preoperative ultrasound indices in the carotid arteries of 64 patients who underwent ESP were retrospectively analyzed. A predictive ultrasound model for the fitted IR after ESP was established.Results: Of the 10 preoperative ultrasound indices, peak systolic velocity (PSV) at stenosis was strongly correlated with postoperative actual IR (r = 0.622; P < 0.01). The unstable plaque index (UPI; r = 0.447), peak eccentricity ratio (r = 0.431), and plaque stiffness index (β; r = 0.512) moderately correlated with actual IR (P < 0.01). Furthermore, the resistance index (r = 0.325) and the dilation coefficient (r = 0.311) weakly correlated with actual IR (P < 0.05). There was no significant correlation between actual IR and the number of unstable plaques, area narrowing, pulsatility index, and compliance coefficient. In combination, morphological, hemodynamic, and physiological ultrasound indices can predict 62.39% of neurological deficits after ESP: fitted IR = 0.9816 – 0.1293β + 0.0504UPI – 0.1137PSV.Conclusion: Certain carotid ultrasound indices correlate with ESP outcomes. The multi-index predictive model can be used to evaluate the effects of ESP before surgery.

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