RESUMO
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 sequelae. 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.
Assuntos
Aorta Torácica/anormalidades , Artéria Subclávia/anormalidades , Artéria Vertebral/anormalidades , Aorta Torácica/patologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/patologia , Feminino , Humanos , Masculino , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/patologia , Fatores de Risco , Artéria Subclávia/patologia , Malformações Vasculares/complicações , Artéria Vertebral/patologia , Dissecação da Artéria Vertebral/etiologia , Dissecação da Artéria Vertebral/patologiaRESUMO
Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports.
A dissecção das artérias cervicais é uma emergência médica. Embora de forma relativamente rara, certas atividades descritas como esportes e recreação podem ser a causa de dissecção arterial independentemente de trauma de crânio ou cervical. O propósito do presente estudo é apresentar uma série de casos de dissecção de artérias cérebro-cervicais em indivíduos durante ou logo após a prática destas atividades desportivas. Métodos Dados retrospectivos de pacientes com dissecção arterial relacionada à prática de esportes e recreação. Resultados Quarenta e um casos foram identificados. A artéria mais frequentemente afetada foi a vertebral. Uma grande variedade de atividades teve relação temporal com a dissecção arterial, sendo a corrida a mais frequente delas. Esta é a maior série de casos da literatura. Conclusão Dissecção arterial pode ser uma complicação da prática de esportes.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Traumatismos em Atletas/complicações , Dissecação da Artéria Carótida Interna/etiologia , Recreação , Esportes/estatística & dados numéricos , Dissecação da Artéria Vertebral/etiologia , Angiografia Cerebral , Dissecação da Artéria Carótida Interna/patologia , Cefaleia/etiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Dissecação da Artéria Vertebral/patologiaRESUMO
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.
Assuntos
Feminino , Humanos , Masculino , Aorta Torácica/anormalidades , Artéria Subclávia/anormalidades , Artéria Vertebral/anormalidades , Aorta Torácica/patologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/patologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/patologia , Fatores de Risco , Artéria Subclávia/patologia , Malformações Vasculares/complicações , Dissecação da Artéria Vertebral/etiologia , Dissecação da Artéria Vertebral/patologia , Artéria Vertebral/patologiaRESUMO
BACKGROUND: Giant aneurysms arising from the vertebral artery (VA) are often associated with thrombosis and present as mass lesions with slow progression of symptoms and signs. A consensus is still to be established on the underlying growth mechanisms and surgical management of thrombosed giant aneurysms of the VA. CASE DESCRIPTION: Here, we report the case of a 54-year-old man who sought neurosurgical care after 3 months of progressive cervical axial pain. He underwent cervical magnetic resonance imaging and cerebral angiography, which revealed a giant VA aneurysm with thrombosed component. After failure of proximal and distal endovascular treatment, it was decided to adopt a surgical approach, which revealed a markedly developed vasa vasorum in the aneurysmal walls, raising the possibility of intra-aneurysmal nutrition from vasa vasorum. The patient recovered progressively and almost completely after surgery. CONCLUSIONS: Another report described the case of a 58-year-old woman harboring a partially thrombosed giant aneurysm of the VA. At the time of resection, a marked development of vasa vasorum on the occluded VA and the neck of the aneurysm was noted. We highlight the need to comprehend vasa vasorum as potential sources for aneurysmal growth.
Assuntos
Procedimentos Neurocirúrgicos , Trombose/cirurgia , Vasa Vasorum , Procedimentos Cirúrgicos Vasculares , Dissecação da Artéria Vertebral/patologia , Dissecação da Artéria Vertebral/cirurgia , Angiografia Cerebral , Progressão da Doença , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Trombectomia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
UNLABELLED: Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. METHODS: Retrospective data on patients with arterial dissection related to sports and recreation. RESULTS: Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. CONCLUSION: Arterial dissection may be a complication from practicing sports.
Assuntos
Traumatismos em Atletas/complicações , Dissecação da Artéria Carótida Interna/etiologia , Recreação , Esportes/estatística & dados numéricos , Dissecação da Artéria Vertebral/etiologia , Adolescente , Adulto , Idoso , Dissecação da Artéria Carótida Interna/patologia , Angiografia Cerebral , Feminino , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Dissecação da Artéria Vertebral/patologia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: We investigated the predictors and time course for recanalization after vertebral artery dissection. METHODS: We prospectively studied 61 consecutive patients with confirmed diagnoses of vertebral artery dissection without intracerebral hemorrhage. Neuroimaging and clinical follow-up were performed at presentation and at 3, 6, and 12 months. RESULTS: We included 61 patients with confirmed vertebral artery dissection; 19 were evaluated and followed up with conventional angiography, 24 with MR angiography, and 18 with CT angiography. Fifty-one patients had a stenotic dissection, 7 had an occlusive dissection, one had a double-lumen image, and 2 had a pseudoaneurysm. The estimated rate of complete recanalization after vertebral artery dissection was 45.9% at 3 months, 62.3% at 6 months, and 63.9% at 12 months. We found no association between outcome and complete or partial recanalization nor did we find any factors associated with recanalization. CONCLUSIONS: These results suggest that recanalization of vertebral artery dissection occurs mainly within the first 6 months after the onset of symptoms regardless of the location or pattern of the dissection.
Assuntos
Angiografia Cerebral/métodos , Dissecação da Artéria Vertebral , Adulto , Circulação Cerebrovascular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fluxo Sanguíneo Regional/fisiologia , Fatores de Tempo , Dissecação da Artéria Vertebral/diagnóstico , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/patologia , Adulto JovemRESUMO
BACKGROUND: Hemimedullary syndrome is very rare and combines the clinical features of lateral and medial medullary infarctions. In patients with hemimedullary syndrome, the presence of ipsilateral, rather than contralateral hemiplegia, is rare. OBJECTIVE: To describe a patient with an infarction in the right hemimedulla with an ipsilateral motor deficit due to dissection of the right vertebral artery (VA) and to assess whether the ipsilateral hemiplegia may be the result of a specific stroke mechanism. METHODS: We reviewed the reports of hemimedullary syndrome in the literature and compared the characteristics of patients with dissection of the VA with those with VA atherosclerotic disease. RESULTS: In our patient, magnetic resonance angiography showed dissection of the right VA to be the cause of the stroke. In a review of the literature (including our case), hemiplegia was ipsilateral to the infarction in four of the five patients with VA dissection, but contralateral in all six patients with atherosclerotic disease of the VA (p=0.01). In all five cases of VA dissection, the right hemimedulla was involved, while, in the six cases of atherosclerotic disease, the left side of the medulla oblongata was affected in five instances and the right side in one (p=0.01). CONCLUSION: Dissection of the VA may provoke a hemimedullary lesion at a lower level than atherosclerosis, thus affecting medullary-penetrating branches that irrigate the medulla immediately below the pyramidal decussation. Hemimedullary syndrome accompanied by ipsilateral motor deficit should raise suspicion of dissection of the VA.
Assuntos
Infartos do Tronco Encefálico/etiologia , Infartos do Tronco Encefálico/patologia , Hemiplegia/etiologia , Bulbo/irrigação sanguínea , Dissecação da Artéria Vertebral/diagnóstico , Adulto , Humanos , Angiografia por Ressonância Magnética , Masculino , Bulbo/patologia , Síndrome , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/patologiaRESUMO
Vertebral artery dissection has been recognized as an uncommon cause of ischemic stroke. However, it is less well known as a cause of subarachnoid hemorrhage. Even if dissecting aneurysms of the vertebral artery are rare, their importance arise from their high morbidity and mortality with rebleeding occurring more often than in cases of saccular aneurysms. Dissecting aneurysms of the vertebrobasilar system are a complex entity which requires a rapid and effective treatment to prevent rerupture. The sole stenting technique stands as a promising approach, allowing to occlude the aneurysm while preserving the vessel patency and reconstructing the diseased segment.