Bilateral Vertebral Angiography Research Articles

Acute Occlusion and Recanalization of Vertebral Artery Dissection After Subarachnoid Hemorrhage: Usefulness of Bilateral Simultaneous Vertebral Angiography and Basiparallel Anatomic Scanning-Magnetic Resonance Imaging

A 41-year-old man presented with subarachnoid hemorrhage. Initial digital subtraction angiography showed occlusion of the right vertebral artery (VA), which recanalized immediately, and dissecting aneurysm on the distal part of the right VA. Basiparallel anatomic scanning (BPAS)-magnetic resonance (MR) imaging showed the morphology of the aneurysm clearly. Coil embolization of the entire affected artery was performed using bilateral vertebral angiography road mapping. Although acute occlusion of ruptured VA dissection may have the potential for natural healing, spontaneous recanalization seems to be hazardous because of rebleeding. In cases with acute occlusion of parent artery, BPAS-MR imaging and bilateral simultaneous vertebral angiography may give useful information.

Dural arteriovenous fistula with spinal perimedullary venous drainage

The purpose of this study was to investigate the characteristics of six patients with dural arteriovenous fistula (DAVF) with drainage directly into the perimedullary venous system. In five patients with subarachnoid hemorrhage (SAH), cerebral angiography revealed a DAVF with spinal venous drainage located at the petrosal sinus in one, at the tentorium in one, and at the craniocervical junction in four. In the patient with myelopathy, angiographic exploration began with a spinal angiogram. Bilateral vertebral angiography initially failed to demonstrate the fistula, and a tentorial DAVF was established with carotid artery angiography. Patients had no myelopathy when the venous drainage was limited to the cervical cord; myelopathy was present when the venous drainage descended toward the conus medullaris. Diagnosis of a DAVF presenting with myelopathy is more challenging than of those presenting with SAH.

Endovascular Treatment of Ruptured Aneurysms Associated With Fenestrated Basilar Artery-Two Case Reports-

Two patients with ruptured aneurysm associated with fenestrated basilar artery (BA) were treated using the endovascular approach. Angiography showed these patients had different types of BA bifurcation. One type had two points of bifurcation and a bridging artery in the BA fenestration, with the aneurysm at the bifurcation of the right loop of the fenestration. The aneurysm had different appearances on right and left vertebral angiograms. The other type had only one point of bifurcation, and the appearance of this aneurysm was similar on both angiograms. To ensure successful embolization, bilateral vertebral angiography should be performed for complete assessment of the morphological characteristics of aneurysm associated with fenestrated BA.

Arteriovenous malformation of the spinal cord in a 17-month-old child.

A case of arteriovenous malformation (AVM) of the cervical spinal cord occurring in a 17-month-old girl is reported. The initial symptom was quadriplegia of abrupt onset. Bilateral vertebral angiography disclosed 6 feeding arteries and a large draining vein. Complete obstruction of the blood supply to the AVM was confirmed angiographically, following cauterization and section of feeders via an anterior approach. Two years after the operation, the patient can sit and move all extremities with residual slight right hemiparesis. This report is the first operative case of cervical cord AVM in a child under 2 years of age.

The effect on the development of cerebral vasospasm in the rat of lesioning of the peripheral and central catecholamine systems

An experimental SAH was produced in the rat by the intracisternal injection of blood. The animals were examined with bilateral vertebral angiography or autoradiographic CBF- and CMRgI-studies. A biphasic vasospasm was seen with a maximal acute spasm at ten minutes and a maximal late spasm at two days post SAH. On day two post SAH, CBF studies demonstrated focal low flow areas in the cortex and caudate-putamen. The CMRgI examinations revealed focal areas with deoxyglucose accumulation corresponding to the low flow areas, suggesting an anaerobic glycolysis. Adrenal demedullation did not change the degree of spasm. Cranial sympathectomy reduced the degree of late spasm by about 50%. Lesioning of the ascending CA pathways in the mesencephalon prior to the SAH, prevented the development of both the acute and the late spasm. It also prevented the development of the focal CBF and CMRgI changes.

Vertebro-basilar ischaemia. Its relation to stenosis and occlusion of the vertebral artery.

Bilateral vertebral angiography has been performed on 44 cases of vertebrobasilar ischaemia (VB I), excluding transient ischaemic attacks, and on 20 cases of carotid ischaemia with lesions of the vertebral artery (VA). Significant lesions (stenosis of more than 50% of the lumen and occlusion) of the VA were found in 72% of VB I and 70% of carotid ischaemia cases. In the VB I group, occlusions are as frequent as stenosis (17 occlusions and 15 stenosis); on the contrary, occlusions are half as frequent as stenosis in the carotid ischaemia group. Bilateral lesions are also more often discovered after VB I than after carotid ischaemia. Topographically, the lesions are mainly at the ostium and in the third portion of the VA. The possibility that vertebro-basilar strokes are related to significant lesions of the VA in its cervical part is emphasized. Haemodynamic disorder can explain infarcts related to bilateral lesions and some of those reported after unilateral lesions. Embolism may be suggested in cases of significant stenosis and of certain unilateral occlusions.

Angiography for intracranial aneurysms of the vertebrobasilar system (author's transl)

Amongst 112 patients with a total of 122 intracranial aneurysms, there were eleven (9%) in the vertebro-basilar system. Four of the vertebral artery aneurysms were situated at the origin of the inferior posterior cerebellar artery, three at the bifurcation of the basilar artery; there were three rare aneurysms situated peripherally on the cerebellar vessels and there was one circumscribed aneurysm of the basilar artery stem. Selective vertebral angiography, with high position of the catheter, is recommended for the demonstration of these aneurysms. If there is insufficient reflux into the opposite vertebral artery from a left-sided injection, bilateral vertebral angiography must be carried out. Special projections, such as transoral (open-mouth) or transfacial may be of advantage. Angiotomography has also proved valuable and magnification can be helpful. Subtraction is particularly indicated for sagittal projections.