scholarly journals Endovascular treatment of a patient with traumatic dissection lesions of both vertebral arteries obtained during chiropractic manipulation

2018 ◽  
Vol 24 (2) ◽  
pp. 77-86
Author(s):  
Yu.V. Cherednychenko ◽  
A.Yu. Miroshnychenko ◽  
L.A. Dzyak ◽  
N.A. Zorin ◽  
S.P. Grygoruk ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Cerebral Angiography ◽  
Left Vertebral Artery ◽  
Chiropractic Manipulation ◽  
Vertebral Arteries ◽  
Coordination Disorders ◽  
Cerebellar Artery ◽  
The Right ◽  
The Brain

The observation of endovascular treatment of a 34-year-old woman with bilateral dissection lesions of vertebral arteries in V4-segments with occlusion of the right vertebral artery and right posterior inferior cerebellar artery, severe stenosis of the left vertebral artery caused by chiropractic manipulation in the neck region is described. There are intensive staticolocomotor and dynamic coordinating insufficiency, severe neck pain, headache, severe dizziness, Wallenberg syndrome, moderate central tetraparesis. MRI of the brain on the DWI Isotropic identified the hyperintensive round-shaped foci in the right hemisphere of the cerebellum, in the right side of cerebellum worm, in the right side of the medulla oblongata and in the right side of the pons (DWI BSS 3). Selective cerebral angiography was performed an hour after the clinic manifestation. Simultaneously, balloon angioplasty of severe dissection stenosis was performed in the V4-segment of the left vertebral artery by the compliant balloon-catheter Scepter C. In 18 hours from the development of vertebral artery dissection, self-expending stent LVIS was implanted into the left vertebral artery in the zone of dissection lesion. On the control angiograms: the left vertebral artery patency is restored without stenosis all along. The stent is fully opened. A second contrast contour is determined outside the stent in the dissection zone. All the arteries of the vertebrobasilar basin above the vertebrobasilar junction are passable. The V4-segment of the right vertebral artery is contrasted through the vertebrobilar junction. There was a rapid regression of neurological symptoms in the postoperative period. Only mild hypoesthesia on the right side in the outer Sölder’s zone, light coordination disorders on the right were remained. Control selective cerebral angiography revealed recanalization of the right vertebral artery and the right posterior cerebellar artery. But distal basin of the right posterior cerebellar artery is very poorly. The left vertebral artery is passable all over, but in the place of the former dissection, two equivalent arterial «sleeves» were formed according to the fenestration type. One «sleeve» is formed by a stent, the other — outside. All arteries of the vertebrobasilar basin are contrasted. The mild hemihepesthesia on the right side of the face in the outer Sölder’s zone, light coordination disorders on the right are remained. Implantation of the self-expanding stent LVIS allowed to restore the dominant vertebral artery and restrict ischemic brain damage in the brain stem and cerebellum in a patient with a both vertebral arteries dissection lesion caused by chiropractic neck manipulations.

scholarly journals Endovascular treatment of the patient with vascular type of Ehlers–Danlos syndrome with bilateral dissection stenoses and aneurysms in V3- andV4- segments of vertebral arteries

2018 ◽  
Vol 24 (2) ◽  
pp. 87-96
Author(s):  
Yu.V. Cherednychenko ◽  
A.Yu. Miroshnychenko ◽  
L.A. Dzyak ◽  
N.A. Zorin ◽  
S.P. Grygoruk ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Balloon Catheter ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Ehlers Danlos Syndrome ◽  
Vertebral Arteries ◽  
Vascular Type ◽  
The Right ◽  
Danlos Syndrome

A case of treatment of a patient with type 4 of Ehlers–Danlos syndrome and bilateral dissection stenoses and aneurysms in V3and V4-segments of vertebral arteries is described. Also another vascular anomaly was verified: the aberrant right subclavian artery (arteria lusoria). Сerebral angiography with dynamic rotation of the neck revealed a bow hunter's syndrom, which consists in the restriction of blood flow in the right vertebral artery when the head is turned to the left. Stage-by-stage endovascular reconstruction of both vertebral arteries was performed. Firstly, LVIS stent was implanted in the left vertebral artery on the level of the dissection lesion. Then, the aneurysm of the left vertebral artery was embolized by detachable coils. Balloon angioplasty was performed in the stented segment with the compliance balloon-catheter Scepter. On the series of angiograms: the aneurysm is totally excluded, the stenosis of the artery is eliminated. After 1 month, the second stage of endovascular treatment in the same volume in the right vertebral artery was performed. At attempts of a hemostasis with the vascular closure device Аngioseal were unsuccessful in both operations. Hemostasis was successfully performed by manual compression of the puncture site. A mutation in the gene COL3A1, responsible for the synthesis of procollagen III type, was confirmed by Ehlers–Danlos syndrome of type 4 (vascular type) at the subsequent genotyping of the patient. The patient's neurological symptoms regressed to a great extent. Endovascular methods can be effective in the treatment of vertebral arteries dissection lesions in patients with vascular type of Ehlers–Danlos syndrome.

scholarly journals Endovascular treatment of tandemic occlusions in acute ischemic stroke

2021 ◽  
Vol 36 (2) ◽  
pp. 73-81
Author(s):  
D.V. Shcheglov ◽  
V.N. Zahorodnii ◽  
S.V. Konotopchik ◽  
A.A. Pastushin
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Internal Carotid ◽  
Left Vertebral Artery ◽  
The Right ◽  
The Brain

The observation of endovascular treatment of acute tandem occlusion of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) in combination with the thrombosis of the right ICA and the critical stenosis of the left vertebral artery is presented.Man, 61 years old. He was delivered to the Center of endovascular neuroradiology, NAMS of Ukraine on January 15, 2021 with an ischemic stroke clinic in the left internal carotid artery basin. He fell ill acutely ‒ against the background of complete well-being, sensorimotor aphasia and right-sided hemiplegia appeared. Upon admission on the NIHSS (National Institutes of Health Stroke Scale) ‒ 18 points. On the performed initial multispiral computed tomography of the brain according to ASPECTS (Alberta Stroke Program Early CT score) ‒ 8 points. In the endovascular operating room, cerebral angiography was performed, followed by surgery aimed at restoring cerebral blood flow. The time from the onset of the disease to the puncture was 330 minutes, the duration of the operation was 135 minutes, thus the time from the onset of the disease to reperfusion was 465 minutes. Angiography revealed acute thrombosis of the left ICA starting from the orifice, M1-segment of the left MCA and A2-segment of the left ACA. Partial compensation of the basin through the supra-block anastomosis (external carotid artery ‒ ICA), as well as from the vertebro-basilar system through the network of leptomeningeal arteries. Collaterals ‒ ACG 3. Thrombosis of the right ICA and critical stenosis (95 %) of the V1-segment of the left vertebral artery were also revealed. The operation was performed ‒ recanalization of thrombosis of the left ICA orifice followed by balloon angioplasty, thrombectomy from the MCA and ACA pools. The end result is eTICI 2c reperfusion. There were no complications during this operation. The patient was discharged the next day (transferred to the neurological department at the place of residence). Control multispiral computed tomography of the brain showed positive dynamics (ASPECTS ‒ 1 point).

scholarly journals Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

2019 ◽  
Vol 12 (8) ◽  
pp. e231335 ◽  
Author(s):  
Sean Thomas O’Reilly ◽  
Ian Rennie ◽  
Jim McIlmoyle ◽  
Graham Smyth
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Left Vertebral Artery ◽  
Basilar Artery Thrombosis ◽  
Direct Puncture ◽  
Alternative Approach ◽  
Cerebellar Artery ◽  
First Pass ◽  
The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

scholarly journals Fourth branch of arch of aorta and its clinical implication

2016 ◽  
Vol 2 (3) ◽  
pp. 24-27
Author(s):  
Rashmi N Gitte ◽  
Chenna Reddy Ganji ◽  
Vishal M Salve
Keyword(s):  
Vertebral Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Left Vertebral Artery ◽  
Branching Pattern ◽  
Human Beings ◽  
Vertebral Arteries ◽  
Brachiocephalic Trunk ◽  
Great Vessels ◽  
The Right

In human beings the most common branching pattern of the aortic arch was its division into three great vessels ie the brachiocephalic trunk, left common carotid artery and the subclavian artery. The vertebral arteries arise from the superior aspect of the first part of the subclavian artery. In present case, a left vertebral artery arose from the aortic arch as fourth branch was found. The diameter of left vertebral artery at its origin was 6 mm as compared to the right vertebral artery, which has diameter of 3.5 mm at its origin. In this case left sixth dorsal intersegmental artery might have persisted as first part of vertebral artery hence left vertebral artery arising from arch of aorta. Knowledge of the variations in branching pattern of the aortic arch is important in the diagnosis of intracranial aneurysm after subarachnoid haemorrhage.J. Biomed. Sci. 2015, 2(3):21-23.

scholarly journals Calcifications of Vertebrobasilar Arteries on CT: Detailed Distribution and Relation to Risk Factors in 245 Ischemic Stroke Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Slaven Pikija ◽  
Jožef Magdič ◽  
Tanja Hojs-Fabjan
Keyword(s):  
Risk Factors ◽  
Vertebral Artery ◽  
Male Gender ◽  
Left Vertebral Artery ◽  
Stroke Patients ◽  
Factors Associated ◽  
Vessel Area ◽  
Vertebral Arteries ◽  
Vertical Dispersion ◽  
The Right

Introduction. Intracranial atherosclerosis is responsible for a substantial proportion of strokes worldwide but its detailed morphology in the vertebrobasilar arteries (VBA) is unknown.Subject and Methods. Cases with ischemic strokes were retrospectively sought from the hospital database. Native CT scans were assessed for vessel area and intracranial artery calcifications (ICACs) in VBA. The calcifications were classified as focal (FCs), crescent, and circular.Results. 245 patients (mean age:77.1±10.2years, 57.6% females) had visible ICACs. Calcifications were found in 75.9%, 63.3%, and 17.1% in the left vertebral artery (LVA), the right vertebral artery (RVA), and the basilar artery (BA), respectively. FCs were present in 91.0%, 90.3%, and 100.0%; crescents in 30.3%, 29.0%, and 7.1%, and circulars in 6.4%, 4.8%, and 0.0% of the RVA, LVA, and BA, respectively. FCs in dorsolateral quadrant were least prevalent in both vertebral arteries (VAs): 46 (29.8%) and 46 (27.4%) for RVA and LVA, respectively. Risk factors associated with vertical dispersion of ICACs were male gender (OR : 2.69, 1.38–5.28) and diabetes (OR : 2.28, 1.04–4.99).Conclusions. FCs in VAs are least prevalent in dorsolateral quadrants. The vertical dispersion of ICACs seems to be associated with the male gender and diabetes.

scholarly journals Retroesophageal right subclavian artery associated with a bicarotid trunk and an ectopic origin of vertebral arteries

2021 ◽  
Author(s):  
Barbara Buffoli ◽  
Vincenzo Verzeletti ◽  
Lena Hirtler ◽  
Rita Rezzani ◽  
Luigi Fabrizio Rodella
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Distal Part ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Vertebral Arteries ◽  
The Right

AbstractA rare branching pattern of the aortic arch in a female cadaver is reported. An aberrant right subclavian artery originated from the distal part of the aortic arch and following a retroesophageal course was recognized. Next to it, from the left to the right, the left subclavian artery and a short bicarotid trunk originating the left and the right common carotid artery were recognized. An unusual origin of the vertebral arteries was also identified. The left vertebral artery originated directly from the aortic arch, whereas the right vertebral artery originated directly from the right common carotid artery. Retroesophageal right subclavian artery associated with a bicarotid trunk and ectopic origin of vertebral arteries represents an exceptional and noteworthy case.

scholarly journals Carotid-Vertebral or Carotid-Subclavian Transpositions in Supra-Aortic Steno-Occlusive Diseases When Endovascular Therapy Is Unfeasible or Unsuccessful

2021 ◽  
Vol 105 (1-3) ◽  
pp. 455-463
Author(s):  
Jian Wang ◽  
Jie Chu ◽  
Lihua Zhang ◽  
Juan Chen ◽  
Yi Zheng ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Endovascular Intervention ◽  
Treatment Modalities ◽  
Left Vertebral Artery ◽  
Severe Stenosis ◽  
Brachiocephalic Trunk ◽  
The Right

Background and purpose Despite advances in endovascular therapies, some patients experience vertebral artery stenosis or subclavian artery occlusion and may not benefit from less-invasive angioplasty/stenting. This study described 4 cases in which carotid-vertebral transposition (CVT) or carotid-subclavian transposition (CST) was adapted when endovascular treatment was unfeasible or unsuccessful. Presentation Case 1: A 65-year-old woman presented with severe stenosis of the right vertebral artery ostium, dysplastic left vertebral artery, and aneurysmal dilatation of proximal right subclavian artery and brachiocephalic trunk. Case 2: A 23-year-woman had severe stenosis at the first portion of left vertebral artery caused by Takayasu's arteritis. Because endovascular intervention was unfeasible, CVTs were performed in cases 1 and 2. Case 3: A 73-year-old man presented with total occlusion of the proximal right subclavian artery and severe stenosis of the right internal carotid artery. Case 4: A 58-year-old man experienced complete occlusion of the left subclavian artery and severe stenosis of the left common carotid artery. Duplex ultrasonography showed reverse flow in the vertebral artery in keeping with vertebral steal syndrome. Endovascular treatment was unsuccessful because the wire did not cross the occlusion of the subclavian artery. CSTs were performed with concurrent ipsilateral carotid endarterectomy in cases 3 and 4. Conclusion The present case series demonstrated that CST and CVT were effective treatment modalities for subclavian or vertebral artery lesions. Although endovascular stenting and angioplasty have been advocated as first-line management, CST and CVT should be considered as the remedy when endovascular intervention is unsuccessful or unfeasible.

scholarly journals Vascularization of the Alouatta belzebul brain base

2020 ◽  
Vol 40 (4) ◽  
pp. 315-323
Author(s):  
Dayane Kelly Sabec-Pereira ◽  
Fabiano C. Lima ◽  
Fabiano R. Melo ◽  
Fabiana Cristina S.A. Melo ◽  
Kleber Fernando Pereira ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Terminal Branch ◽  
Vertebral Arteries ◽  
Caudal Portion ◽  
Cerebellar Artery ◽  
The Right ◽  
The Brain ◽  
Left Middle

ABSTRACT: We studied the arterial circle in the brain of five specimens of the Alouatta belzebul primate. The material had the arterial system perfused (water at 40°C), injected with stained latex (Neoprene 650), fixed in aqueous formaldehyde solution (10%) and dissected for vessel verification. The arterial circle of this primate is composed of two vascular systems: the vertebra-basilar and the carotid ones, which anastomose to close the arterial circuit. In the caudal portion of the arterial circle, there are the vertebral arteries and their branches: the rostral spinal artery and the caudal inferior cerebellar artery. The anastomosis of the vertebral arteries gives rise to the basilar artery. It presented an anatomical variation at the beginning of its path, forming a double basilar artery, called arterial island. In its course, it emitted branches giving rise to the rostral inferior cerebellar artery, the pontine arteries, the rostral cerebellar arteries, the satellite rostral cerebellar arteries and its terminal branch, the caudal cerebral artery, which presented itself in two segments: the pre-communicating one and post-communicating, joining the internal carotid artery and originating the caudal communicating artery. This group of arteries and anastomoses enclose the caudal portion of the arterial circle. From the right and left internal carotid arteries begins the rostral portion of the arterial circle, which consists of the right and left rostral cerebral arteries and the right and left middle cerebral arteries. The rostral cerebral arteries anastomose into a single trunk, giving rise to the interhemispheric artery, and in A. belzebul and Sapajus libidinosus, the rostral communicating artery is absent. The interhemispheric artery goes to the midbrain region and the corpus callosum knee divides into pericalous artery and callosarginal artery, which will supply the pre and post-central regions of the cerebral hemispheres of this species, as well as other non-human and human primates. It is noted that in the first part of the left rostral cerebral artery, there is a direct inosculation between the recurrent branch of the rostral cerebral artery and left middle cerebral artery to supply the entorhinal region. This fact also occurs in Pongo spp. The middle cerebral artery travels along the lateral sulcus where it emits several superficial branches to irrigate the superior and inferior lateral cortical regions of the frontal, parietal and temporal lobes. It is not part of the arterial circle but is the terminal branch of the internal carotid artery. A. belzebul can be considered to depend on two sources of supply to the brain: the vertebra-basilar and carotid systems, contributing to the intervention of veterinarians during clinical and surgical procedures in other primates, as well as the preservation of wild animals.

Incidental identification of the aberrant origin of left vertebral artery using magnetic resonance angiography: A case report

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Forough Sodaei ◽  
◽  
Vahid Shahmaei ◽  
Maryam Noroozian ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
External Carotid Artery ◽  
Left Vertebral Artery ◽  
External Carotid ◽  
Vertebral Arteries ◽  
The Brain

Background: The vertebral arteries originate from the root of the neck as the first branches of the subclavian arteries. Variations of vertebral arteries are congenital anomalies occurring during embryonic development. Anatomic variations of the left vertebral artery are clinically symptomless and recognized incidentally during angiographic assessments or imaging techniques so the diagnosis of these anomalies is a serious challenge. Anomalous origin of vertebral arteries may lead to neurologic disorders. It is, thus, important to identify variations of the large vessels of the aortic arch when planning neck and cervical spine interventions and diagnostic radiology. For this reason, we would like to present this rare case of left vertebral artery showing a different origin. Case report: In this work, we describe a 60-year-old female patient with headache, lethargy and blurred vision. We employed magnetic resonance angiography for both the brain and neck. There was no lesion in the brain. Incidentally, we found that the root of the left vertebral artery was anatomically aberrant. The left vertebral artery arose from the nearest section of the left external carotid artery, next to the bifurcation of the left common carotid artery, which is a rare variation. Conclusion: Understanding the state of anomalous variations of the origin of the vertebral artery might have crucial implications in angiographic and surgical procedures. It is beneficial to perform more screening with noninvasive studies like neck magnetic resonance angiography in clinical cases with potential symptoms coexisting with other diseases in order to predict possible future problems in intracranial and extracranial interventions. Keywords: Vertebral artery; external carotid artery; anatomic variation; magnetic resonance angiography.

scholarly journals ANOMALOUS PREVERTEBRAL COURSE OF THE LEFT VERTEBRAL ARTERY. Recorrido prevertebral anómalo de la arteria vertebral izquierda

2016 ◽  
Vol 6 (3) ◽  
pp. 176-179
Author(s):  
Prakash B Billakanti
Keyword(s):  
Vertebral Artery ◽  
Present Report ◽  
Left Vertebral Artery ◽  
Thoracic Region ◽  
Developmental Mechanism ◽  
Arch Of The Aorta ◽  
The Right ◽  
The Brain ◽  
Variant Anatomy ◽  
Insight Into

La arteria vertebral es una de las arterias que irriga el cerebro. El conocimiento de la anatomía normal y las variantes de la arteria vertebral adquiere importancia en la práctica clínica y la radiología vascular. El origen anómalo de la arteria vertebral del arco de la aorta o cualquiera de las arterias del cuello ha sido reportado por muchos autores. En este informe se presenta una variación del curso prevertebral de la arteria vertebral izquierda. La arteria vertebral tenía su origen habitual en la arteria subclavia con un largo curso prevertebral y entraba en el foramen transversarium de la vértebra CII. El origen y recorrido de la arteria vertebral en el lado derecho fue normal. Clínicamente es importante conocer el origen y curso del segmento prevertebral de la arteria vertebral y las posibles variaciones. El presente informe debería ser de interés para el médico vascular con respecto a las variaciones en el cuello y región torácica, y puede dar idea para dilucidar el mecanismo de desarrollo de la angiogénesis. Vertebral artery is one of the arteries supplying the brain. Knowledge of the normal and variant anatomy of the vertebral artery assumes importance in clinical practice and vascular radiology. Anomalous origins of the vertebral artery from the arch of the aorta or any one of the arteries of the neck have been reported by several authors. In this report a variation of the prevertebral course of the left vertebral artery is being presented. The Vertebral artery had usual origin from the subclavian artery and had a longer prevertebral course to enter the foramen transversarium of the CII vertebra. The origin and course of the vertebral artery on the right side was normal. It is clinically important to know the origin and course of the prevertebral segment of the vertebral artery and possible variations. The present report should be of interest for clinicians with regard to vascular variations in the neck and thoracic region, and may give insight into elucidating the developmental mechanism of angiogenesis.

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