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.
Highlights
The vertebral artery (VA), which usually arises from the posterosuperior aspect of the first part of the subclavian artery and enters into the intracranial space via the dura mater at first cervical vertebra (C) and reaches C6 after traveling through the foramen transversarium, is an important blood supply of the brainstem and cerebellum[1]
Aberrant origin of VA is a rare variant of VA pathologies implicating in cerebrovascular events, and VA dissection[4] and surgical anatomy of local regions in particular in the operation of the carotid artery[5] or aortic arch[6]
Ding et al.[48] reported a cadaver series of 12 VAs with an aberrant origin, which were all presented on the left, arising from the aortic arch (83.3%) (75% of which originated from the arch between the left common carotid and left subclavian arteries), left common carotid (8.3%) and left external carotid arteries (8.3%)
Summary
The vertebral artery (VA), which usually arises from the posterosuperior aspect of the first part of the subclavian artery and enters into the intracranial space via the dura mater at first cervical vertebra (C) and reaches C6 after traveling through the foramen transversarium, is an important blood supply of the brainstem and cerebellum[1]. VA pathologies, including anomalous origin and course, dual arteries, duplication, fenestration, tortuosity, elongation, kinking, arachnoid cysts, aneurysmal formation and associated hereditary connective tissue disorder, implicate typically in cerebrovascular events as a source of blood supply of posterior circulation[2]. Aberrant origin of VA is a rare variant of VA pathologies implicating in cerebrovascular events, and VA dissection[4] and surgical anatomy of local regions in particular in the operation of the carotid artery[5] or aortic arch[6]. The ‘‘vertebral arteria lusoria’’, even more rarely seen, should be considered in the patients undergoing esophageal surgery, and unawareness of such an aberrant VA may cause life-threatening events[7].
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