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Jabre R. Applied anatomy of the vertebral arteries for endovascular neurointerventions. Neurochirurgie 2024; 70:101531. [PMID: 38277862 DOI: 10.1016/j.neuchi.2024.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
The vertebral arteries (VAs) constitute most of the arterial supply to the posterior cerebral vascular circulation. They have anatomical specificities and may have variants that are critical for neurointerventionists to recognize in order to design open or endovascular surgical treatment. This review addresses each segment of the VA including its origin and discusses the branches and relevant anatomical features for neurointerventions.
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Affiliation(s)
- Roland Jabre
- Service de Neurochirurgie, Département de Chirurgie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Division de Neurochirurgie, Département de Chirurgie, Université de Montréal, Montréal, Québec, Canada.
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Bonasia S, Di Caterino F, Robert T. Embryology of the vertebral artery and variants of the adult. Neurochirurgie 2024; 70:101517. [PMID: 38277860 DOI: 10.1016/j.neuchi.2023.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/28/2024]
Abstract
The vertebral arteries represent in the adult the main blood supply of the posterior cranial fossa, even if they appear relatively late during the embryological life. We reviewed all the most important steps of the vertebral artery's embryological development and the most common variants that can occur in the adult. The aim of this review is to summarize the main events of the development of this artery and to give an embryological explication for the most common variants of this artery.
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Affiliation(s)
- Sara Bonasia
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
| | - Fortunato Di Caterino
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Thomas Robert
- University of Southern Switzerland, Lugano, Switzerland
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Srivastava T, Jain RS, Gupta A, Pemawat A. Posterior Circulation Ischemic Stroke in Association with Vertebral Artery Duplication: A Case Report and Review of Literature. Ann Indian Acad Neurol 2023; 26:1017-1019. [PMID: 38229620 PMCID: PMC10789393 DOI: 10.4103/aian.aian_652_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
| | - Rajendra S. Jain
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Ashish Gupta
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Ashish Pemawat
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
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Dual origin of vertebral artery and intimal relationship with spontaneous artery dissection: a case report and systematic review. Surg Radiol Anat 2021; 43:459-465. [PMID: 33420866 DOI: 10.1007/s00276-020-02638-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
Dual origin of the vertebral artery (VA) is an uncommon anatomical variation. We describe a case of duplication origin at right vertebral artery (RVA) found incidentally in one elderly patient on investigation for cerebral aneurysm. Angiogram study showed a pseudoaneurysm at V4 segment of the RVA associated with embryological anatomy. The authors performed a systematic review of the similar cases reported worldwide.
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Lazaridis N, Piagkou M, Loukas M, Piperaki ET, Totlis T, Noussios G, Natsis K. A systematic classification of the vertebral artery variable origin: clinical and surgical implications. Surg Radiol Anat 2018; 40:779-797. [PMID: 29459992 DOI: 10.1007/s00276-018-1987-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 02/05/2018] [Indexed: 12/31/2022]
Abstract
Several congenital anomalies regarding the right (RVA) and left (LVA) vertebral artery have been described. The current paper aims to perform a systematic literature review of the variable vertebral artery (VA) origin from the aortic arch (AOA) and its branches. The incidence of these variants and the ensuing AOA branching pattern are highlighted. Atypical origin cases were found more commonly unilaterally, while LVA presented the majority of the aberrancies. The LVA emersion from the AOA (3.6%) and the RVA from the right common carotid artery (RCCA) (0.14%) were the commonest origin variations. Aberrant RVA origin as last branch of the AOA is very rare. Eighteen cases (0.12%) with an aberrant right subclavian artery (ARSCA) were found. Among them, the RVA originated from the RCCA and right subclavian artery in 94.4 and 5.6%, respectively. Sporadic cases had an AOA origin bilaterally; RVA and LVA had a double origin in 0.027 and 0.11%, respectively. A dual origin was detected in 0.0069%, bilaterally. The atypical VA origin may coexist with: (i) an ARSCA, (ii) a common origin of brachiocephalic artery and left common carotid artery (the misnomer bovine arch) and (iii) a bicarotid trunk. The aberrant VA origin favors hemodynamic alterations, predisposing to cerebrovascular disorders and intracranial aneurysm formation. Detailed information of VA variants is crucial for both endovascular interventionists and diagnostic radiologists involved in the treatment of patients with cerebrovascular disease. Such information may prove useful to minimize the risk of VA injury in several procedures.
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Affiliation(s)
- Nikolaos Lazaridis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece
| | - Maria Piagkou
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, Saint George's, Grenada
| | - Evangelia-Theophano Piperaki
- Department of Microbiology, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Trifon Totlis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece
| | - Georgios Noussios
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece.
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Kim MS. Duplicated Vertebral Artery : Literature Review and Clinical Significance. J Korean Neurosurg Soc 2017; 61:28-34. [PMID: 29354233 PMCID: PMC5769842 DOI: 10.3340/jkns.2017.0202.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/07/2017] [Accepted: 04/26/2017] [Indexed: 12/02/2022] Open
Abstract
Objective Duplication of the vertebral artery (VA) is a rare vascular variant. This paper describes the anatomy and embryological development of duplicated VAs and reviews the clinical significance. Methods Computed tomography (CT) angiography was performed in 3386 patients (1880 females, 1506 males) between March 2014 and November 2015. We defined duplication of the VA as a condition in which the VA has two origins that fused at different levels of the neck. Results Ten of the 3386 patients (0.295%) who received CT angiography had a dual origin of the VA; three on the left side, and seven on the right side. In all seven with right dual origin of the VA, both limbs of the VA origin originated from the right subclavian artery. In all three patients with left dual origin of the VA, both limbs of the VA originated from the left subclavian artery and aortic arch. In all 10 patients, the medial limb of the duplicated VA was located posteriorly and medially to the common carotid artery (CCA) and anteriorly and laterally to the vertebral transverse foramen. In two patients, the medial limb of the duplicated VA was located in close proximity to the CCA. In another two patients, the medial limb of the duplicated VA was located in close proximity to the CCA, carotid bifurcation, and proximal internal carotid artery. Conclusion Although duplication of the VA is asymptomatic in most patients, clinicians should consider this anomaly during diagnosis and treatment.
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Yuan SM. Aberrant Origin of Vertebral Artery and its Clinical Implications. Braz J Cardiovasc Surg 2016; 31:52-9. [PMID: 27074275 PMCID: PMC5062690 DOI: 10.5935/1678-9741.20150071] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/03/2015] [Indexed: 11/20/2022] Open
Abstract
Aberrant origin of vertebral artery is rare. The anatomical features and clinical
significance of this lesion remain to be clarified. A comprehensive collection
of the pertinent literature resulted in a cohort of 1286 cases involving 955
patients and 331 cadavers. There were more left than right and more unilateral
than bilateral aberrant vertebral arteries. Patients with aberrant origin of
vertebral artery were often asymptomatic and in only 5.5% of the patients their
symptoms were probably related to the aberrant origin of vertebral artery. The
acquired cardiovascular lesions were present in 9.5% of the patients, 20.9% of
which were vertebral artery-associated lesions. Eight (0.8%) patients had a
vertebral artery dissection. Logistic regression analysis showed significant
regressions between bovine trunk and left vertebral artery
(P=0.000), between the dual origins of vertebral artery and
cerebral infarct/thrombus (P=0.041), between associated
alternative congenital vascular variants and cervical/aortic
dissection/atherosclerosis (P=0.008). Multiple logistic
regression demonstrated that side of the aberrant origin of vertebral artery
(left vertebral artery) (P=0.014), arch branch pattern (direct
arch origin) (P=0.019), presence of the common trunk
(P=0.019), associated acquired vascular disorder
(P=0.034) and the patients who warranted management
(P=0.000) were significant risk predictors for neurological
sequelea. The patients with neurological symptoms and those for neck and chest
operations/ interventions should be carefully screened for the possibility of an
aberrant origin of vertebral artery. The results from the cadaver metrology
study are very helpful in the design of the aortic stent. The arch branch
pattern has to be taken into consideration before any maneuver in the local
region so as to avoid unexpected events in relation to aberrant vertebral
artery.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, China
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Baik J, Baek HJ, Shin HS, Choi KH. Duplication of the right vertebral artery: MRA findings and review of the literature. SPRINGERPLUS 2016; 5:1123. [PMID: 27478740 PMCID: PMC4951390 DOI: 10.1186/s40064-016-2807-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
Introduction Duplication of the vertebral artery (VA) is a rare vascular variant. To the best our knowledge, only fourteen cases have been reported with angiographic findings that they have dual origin of the VA from ipsilateral subclavian artery. Herein, we present a case of duplication of right VA which was incidentally detected by magnetic resonance (MR) angiography. Case description A 69-year-old female patient presented with headache for 30 days. She underwent brain MR imaging with MR angiography for evaluating possible intracranial cause. There was a dual origin of the right vertebral artery (VA) as an incidental finding without other significant abnormalities. Discussion and Evaluation Diagnosis of duplicated VA can be difficult due to its rarity and misinterpreted as the vascular dissection. In addition, a detailed knowledge of this variation is potentially important to prevent inadvertent challenges during endovascular procedure. Because duplicated VA has smaller lumen and usually enters the higher transverse foramen than those of normal side, it can be influence the choice or route of endovascular treatment. Conclusions We suggested that the understanding of embryologic background about VA can be helpful to identify unexpected vascular findings on imaging studies in clinical practice.
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Affiliation(s)
- Jiyeon Baik
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108 Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472 Republic of Korea
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727 Republic of Korea
| | - Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, 50612 Republic of Korea
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Flesarova S, Mazensky D, Supuka P. Study of possible anatomical arrangement of the vertebral artery in guinea pig. Biologia (Bratisl) 2015. [DOI: 10.1515/biolog-2015-0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Polguj M, Podgórski M, Jędrzejewski K, Topol M, Majos A. Fenestration and duplication of the vertebral artery: the anatomical and clinical points of view. Clin Anat 2013; 26:933-43. [PMID: 23553773 DOI: 10.1002/ca.22231] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/20/2012] [Accepted: 01/17/2013] [Indexed: 11/07/2022]
Abstract
The vertebral artery (VA) acts as a foundation for the posterior circulation of the head and neck. It presents a number of anomalies that can be easily visualized thanks to modern imaging techniques, such as MR and CT angiography or color Doppler ulrasonography. Determining the appropriate terminology for those anomalies can be sometimes more challenging than their recognition. One particular challenge concerns the differentiation between VA fenestration and duplication. Because of the different clinical prognoses associated with those anomalies, confusion should be avoided. Knowledge of the morphological anomalies associated with the VA is important for both radiologists and head and neck surgeons, because any injury to the VA can result in a threat to the vascular supply of the brain stem, the cerebral or cerebellar hemispheres, the thalamus, cervical nerve roots and particularly the lateral medulla (Wallenberg's syndrome). This article analyses world literature concerning the issue of VA fenestration and duplication to facilitate a differential diagnosis.
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Affiliation(s)
- Michał Polguj
- Department of Angiology, Chair of Anatomy, Medical University of Łódź, 90-136, Łódź, Narutowicza 60, Poland
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Duplication of the left vertebral artery in a patient with dissection of the right internal carotid artery and Ehlers-Danlos syndrome: case report and review of the literature. Anat Sci Int 2012; 88:109-14. [PMID: 22956231 PMCID: PMC3575557 DOI: 10.1007/s12565-012-0152-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 08/16/2012] [Indexed: 11/12/2022]
Abstract
Duplication of the left vertebral artery was observed in a 43-year-old Caucasian male with dissection of the right internal carotid artery during multidetector 64-row computer tomography and Doppler ultrasonography B-flow mode. Both duplicated segments arose from the left subclavian artery and united at levels C5–C6 to form a single vessel. The presented case describes precisely the origin and diameter of both vertebral arteries. Additionally, after all procedures associated with diagnosis and treatment of the patient, Ehlers–Danlos syndrome type IV was diagnosed. The lumen of the duplicated vertebral artery was smaller than normal; it can be concluded that this variant has clinical implications and should be taken into consideration when vertebral arteries need catheterization.
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Tobin WO, Killeen R, Kinsella JA, McCabe DJH. Dual origin of the left vertebral artery: extracranial MRA and CTA findings. J Neurol Sci 2011; 298:150-2. [PMID: 20810134 DOI: 10.1016/j.jns.2010.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/15/2010] [Accepted: 07/21/2010] [Indexed: 11/27/2022]
Abstract
A 48-year-old man presented with a posterior circulation stroke secondary to left lateral medullary infarction. Contrast-enhanced magnetic resonance angiography (CEMRA) revealed 40-45% intracranial left vertebral artery stenosis, likely atherosclerotic in nature. CEMRA and subsequent computed tomography angiography also identified a duplicate origin of the left vertebral artery. The importance of recognition of this rare anatomical variant, its potential contribution to stroke aetiology, and the advantage of non-invasive vascular imaging prior to catheter angiography is emphasised.
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Affiliation(s)
- W Oliver Tobin
- Department of Neurology, The Adelaide and Meath Hospital, Trinity College Dublin, Ireland
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KENDI ATK, BRACE JR. Vertebral artery duplication and aneurysms: 64-slice multidetector CT findings. Br J Radiol 2009; 82:e216-8. [DOI: 10.1259/bjr/26005109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Mordasini P, Schmidt F, Schroth G, Remonda L. Asymmetrical bilateral duplication of the extracranial vertebral arteries: Report of a unique case. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.ejrex.2008.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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