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.

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.

scholarly journals OPTIMIZATION OF SURGICAL TREATMENT OF VERTEBRAL ARTERY TORTUOSITY

2020 ◽  
pp. 440-447
Author(s):  
D.D. SULTANOV ◽  
◽  
A.D. GAIBOV ◽  
O. NEMATZODA ◽  
KH.A. YUNUSOV ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Internal Carotid ◽  
Vascular Pathology ◽  
Long Term Results ◽  
Vertebrobasilar Insufficiency ◽  
Surgery Technique ◽  
Reconstructive Operations

Objective: Analysis of the results of standard and optimized surgical treatment of vertebral artery (VA) tortuosity. Methods: The results of surgical treatment of 52 patients with VA tortuosity were analyzed. There were 18 men (34.6%), and 34 women (65.4%). The age of patients ranged from 23 to 75 years. C- and S-shaped kicking of VA occurred in 38 cases, coiling in 8 cases and Powers syndrome in 6 cases. In 28 (53.8%) patients there was also hypoplasia of the contralateral VA, and in 7 (13.5%) cases there was a pathological deformation of the internal carotid artery. Results: Depending on the shape of the tortuosity, 4 techniques of reconstructive operations were performed to eliminate tortuosity. In the postoperative period thrombosis of the anastomosis line noted in 2.8% of cases, TIA – in 1.9%, and stroke – in 1.9%. The immediate and long-term results in the groups showed the effectiveness and best results in the group of patients who underwent lateralization of the VA of the author’s modification. Also established that for VA coiling, the method of choice is to move and implantation of VA into the carotid artery. Conclusions: Correction of VA tortuosity should be differentiated, and the choice of the method of surgery technique should depend on the type of tortuosity and concomitant vascular pathology. The lateral and anterior moving VA ostium helps to reduce the rate of anastomosis thrombosis and greatly facilitates the surgery technique. Keywords: Vertebral artery, tortuosity, kinking, coiling, vertebrobasilar insufficiency, chronic cerebral ischemia, surgical treatment.

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.

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.

Carotid to distal vertebral artery bypass for vertebrobasilar ischemia

1984 ◽  
Vol 60 (1) ◽  
pp. 187-189 ◽  
Author(s):  
Perry E. Camp
Keyword(s):  
Vertebral Artery ◽  
Simple Technique ◽  
Artery Bypass ◽  
Vertebrobasilar Insufficiency ◽  
Venous Graft ◽  
Content Type ◽  
Vertebrobasilar Ischemia ◽  
Extracranial Vertebral Artery ◽  
The Common ◽  
Collateral Vessels

✓ A simple technique is described for a venous graft between the common carotid artery and the extracranial vertebral artery. In the case described, the vertebral artery was shown angiographically to be occluded and reconstituted by collateral vessels. This patient had symptoms of vertebrobasilar insufficiency which resolved postoperatively.

Transient rotational compression of the vertebral artery caused by herniated cervical disc

2003 ◽  
Vol 98 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Andrew N. Nemecek ◽  
David W. Newell ◽  
Robert Goodkin
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Cervical Disc ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Vertebrobasilar Ischemia ◽  
Extrinsic Compression ◽  
The Many ◽  
Herniated Cervical Disc ◽  
Adequate Decompression

✓ Of the many causes of vertebrobasilar insufficiency (VBI), extrinsic compression of the vertebral artery (VA) is relatively uncommon. A syndrome of VBI caused by extrinsic compression of the VA secondary to head rotation has been termed positional vertebrobasilar ischemia. The authors present a case of transient VBI caused by herniation of a cervical disc. Transcranial Doppler ultrasonography was used preoperatively to confirm the diagnosis and intraoperatively to monitor cerebral perfusion and to confirm that adequate decompression of the VA had been achieved.

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 Congenital Bilateral C2 Transverse Foramina Stenosis Causing Adult-Onset Vertebrobasilar Insufficiency and Posterior Circulation Stroke

2017 ◽  
Vol 9 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Ajeet Gordhan ◽  
Catherine Lockhart
Keyword(s):  
Computed Tomography ◽  
Vertebral Artery ◽  
Head And Neck ◽  
Computed Tomography Angiography ◽  
Congenital Anomalies ◽  
Brain Mri ◽  
Posterior Circulation ◽  
Vertebrobasilar Insufficiency ◽  
Adult Onset ◽  
Vertebral Arteries

Vertebrobasilar insufficiency leading to posterior circulation infarcts caused by congenital hypoplasia of the bilateral transverse foramina at the C2 level, affecting the caliber and flow of the bilateral distal cervical vertebral arteries in an adult, has not been previously reported. A 41-year-old male presented with episodic dizziness for a period of 1 year prior to consultation. Computed tomography angiography of the head and neck demonstrated congenital hypoplasia of the bilateral C2 transverse foramina, with absence of the vertebral arteries in each of the foramina and collateral reconstitution of diminutive intracranial vertebral artery segments. Brain MRI showed postinfarction encephalomalacia in the bilateral cerebellar hemispheres. The patient was considered not a surgical or endovascular candidate and was managed conservatively with antiplatelet therapy. Congenital anomalies of the bilateral cervical transverse foramina may present with vertebrobasilar insufficiency and infarction in adulthood.

scholarly journals Slankstelinių arterijų distalinės dalies rekonstrukcijų dažnis vertebrobazilinės išemijos atveju

2003 ◽  
Vol 1 (1) ◽  
pp. 0-0
Author(s):  
Kęstutis Laurikėnas
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Anatomical Changes ◽  
Vertebral Arteries ◽  
Vertebrobasilar Ischemia ◽  
Vertebrobasilar Stroke ◽  
Vilnius University ◽  
Angiographic Examination ◽  
Vertebral Artery Reconstruction ◽  
Artery Reconstruction

Kęstutis LaurikėnasVilniaus universiteto Neurologijos ir neurochirurgijos klinikaVilniaus greitosios pagalbos universitetinės ligoninėsNeuroangiochirurgijos centro Kraujagyslių chirurgijos skyrius Įvadas / tikslas Šiuo metu chirurgų požiūris į operacinio gydymo naudą slankstelinių arterijų patologijos, arba vadinamosios užpakalinės galvos smegenų kraujotakos nepakankamumo, atvejais yra gana nevienodas. Pagrindinis šio tyrimo tikslas – išsiaiškinti, kokiai įvairiomis vertebrobazilinės kraujotakos nepakankamumo formomis sergančių ligonių daliai liga yra sukelta slankstelinių arterijų užakimo ir jų stenozės kauliniuose kanaluose ir kada chirurginiam gydymui pavyksta sėkmingai pritaikyti distalinės slankstelinės arterijos dalies rekonstrukcijos operaciją. Ligoniai ir metodai Straipsnyje nagrinėjami 1677 ligonių, sergančių galvos smegenų kraujotakos išemija, tyrimo ir gydymo duomenys. Daugiausia dėmesio kreipiama į ligos struktūrą, konservatyvaus ir chirurginio gydymo metodų taikymo dažnį. Rezultatai Nustatyta, jog 75 % (1259 ligoniai) visų šių stacionare gydytų galvos smegenų kraujotakos sutrikimų sudarė vertebrobazilinės kraujotakos nepakankamumas, kuris dažniau pasitaiko moterims (66,4 %). Vertebrobazilinis insultas yra dažnesnis nei praeinantys kraujotakos sutrikimai ir sudaro 65,5 % (825 stacionaro ligoniai) vertebrobazilinės kraujotakos nepakankamumo atvejų. Patomorfologiniai slankstelinių arterijų pokyčiai nustatyti tik 720 ligonių, kuriems buvo vertebrobazilinė simptomatika (57,2 % šios ligos atvejų). Mūsų duomenimis, miego arterijų stenozė buvo susijusi su vertebrobaziline simptomatika tik 93 (7,4 %) ligoniams iš 1259 vertebrobazilinės išemijos atvejų. Išvados Operacinis gydymas buvo indikuojamas tik 298 (23,7 %) ligoniams, sergantiems vertebrobaziliniu kraujotakos nepakankamumu. Slankstelinės arterijos distalinės dalies rekonstrukcija atlikta 15 ligonių ir šios operacijos sudarė 5,1 % visų slankstelinių arterijų rekonstrukcinių operacijų. Jos atliktos tik 1,2 % ligonių, turinčių vertebrobazilinę simptomatiką. Prasminiai žodžiai: slankstelinė arterija, vertebrobazilinė išemija, chirurginis gydymas, slankstelinės arterijos distalinės dalies rekonstrukcija. Distal vertebral artery reconstruction: surgical possibilities in vertebrobasilar ischemia Kęstutis Laurikėnas Background / objective This study highlights the rate of surgical activities in cases of vertebrobasilar ischemia. Patients and methods In the last years in the neurological and vascular surgery clinics of Vilnius University Emergency Hospital 1259 patients were treated for vertebrobasilar ishemia and 298 patients (23.7%) underwent vertebral artery reconstruction. Results Only in 57.2% of cases of vertebrobasilar ishemia did we find pathological anatomical changes in vertebral arteries. In 83 cases the vertebral artery was occluded, in 413 cases vertebral arteries were herniated into canalis osseus by osteochondrosis. In 825 cases (65.5%) vertebrobasilar stroke occurred. Conclusions After CT and angiographic examination only 15 distal vertebral artery reconstructions were performed, i. e. 5.1% of all operations on vertebral artery and 1.2% of all vertebrobasilar patients. Keywords: vertebral artery, vertebrobasilar ishemia, surgical treatment, distal vertebral artery reconstruction.

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