Vertebral Artery Stenosis Research Articles

The Relationship Between Tortuosity and Stenosis of Extracranial Internal Carotid Arteries and Vertebral Arteries Based on Cerebral Digital Subtraction Angiography and Vascular Risk Factors at Pelni Hospital

Background and purpose: Vascular dysfunction is the main key to cardiovascular, cerebrovascular, neurodegenerative diseases, and the aging process causes disruption of blood vessel function. Vascular Tortuosity (VT) and stenosis are types of blood vessel deformities resulting from vascular dysfunction. Both conditions can be diagnosed through cerebral Digital Subtraction Angiography (DSA) examination. This study aims to analyze the relationship between tortuosity and stenosis of extracranial internal carotid arteries and vertebral arteries on vascular risk factors at Pelni Hospital. Methode: This research was a descriptive observational study with a cross-sectional approach on 608 subjects with a history of stroke who met the inclusion criteria. Conducted from January to September 2024, analyzing demographic data and risk factors, the presence or absence of stenosis and Vascular Tortuosity through cerebral DSA, also correlation these factors. Result: From the 608 patients, 334 (54.9%) were male and 274 (45.1%) were female. Most of the subjects were aged 41-59 years (31.1%) with the most common risk factor being hypertension (76.6%). Carotid stenosis was significantly associated with age 51-59 years [odds ratio (OR): 2.452, 95% confidence interval (CI): 1.102-2.481, p=0.031)], female gender (OR): 1.665, 95% CI: 1.102-2.481, p=0.015; and hypertension (OR): 1.761, 95% CI: 1.099-2.821, p=0.019. Vertebral stenosis was significantly associated with female gender (OR): 2.160, 95% CI: 1.176-3.968, p=0.013; and diabetes (OR): 2.079, 95% CI: 1.015-4.255, p=0.045. Both stenosis conditions were significantly correlated with tortuosity conditions with OR: 2.320 for carotid, and OR: 12.090 for vertebral. Carotid tortuosity was significantly associated with diabetes (OR): 2.049, 95% CI: 1.051-4.000, p=0.035. Vertebral tortuosity was significantly associated with dyslipidemia (OR): 2.710, 95% CI: 1.099-6.711, p=0.030 and hypertension (OR): 2.079, 95% CI: 1.234-3.496, p=0.006. The combination of carotid stenosis and tortuosity was significantly associated with female gender (OR): 2.367, 95% CI: 1.378-4.066, p=0.002. The combination of stenosis and tortuosity in both arteries did not show a significant correlation with existing risk factors. Conclusion: Carotid stenosis is correlated with female gender, age, and hypertension. Vertebral stenosis is correlated with female gender and diabetes. Carotid tortuosity is correlated with diabetes. Vertebral tortuosity correlates with dyslipidemia and hypertension. The combination of carotid stenosis and tortuosity correlates with female gender. Keywords: Vascular Tortuosity, Stenosis, Cerebral Digital Subtraction Angiography

Application of microsurgical surgery in patients with proximal vertebral artery stenosis unsuited for endovascular treatment: a single-center retrospective study

To investigate the clinical efficacy and safety of microsurgical surgery in patients with proximal vertebral artery stenosis unsuitable for endovascular treatment. A retrospective analysis was conducted on the clinical data of 34 patients with proximal vertebral artery stenosis who underwent microsurgical surgery at the Department of Cerebrovascular Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, from March 2020 to April 2023. Preoperative imaging confirmation of proximal vertebral artery stenosis or occlusion was obtained using cervical CT angiography (CTA), CT perfusion imaging (CTP), and magnetic resonance angiography (MRA). Postoperative imaging examinations were utilized to evaluate blood flow patency, and clinical symptoms and complications during hospitalization and follow-up were documented. Postoperative imaging examinations in the 34 patients (Males: 79.4%; Mean age: 66.7 ± 9.6 years) revealed patent vertebral and supplying arteries. No new instances of transient ischemic attacks (TIAs) or other cerebrovascular events were observed during hospitalization, and clinical symptoms were improved. The mean follow-up duration was 10 months (range: 6–39 months). One patient died from septic shock due to abdominal infection, and one patient exhibited moderate ipsilateral vertebral artery stenosis on a follow-up CTA at 6 months postoperatively. The Modified Rankin Scale (mRS) scores decreased for 30 patients after surgery compared to preoperative scores, with all postoperative mRS scores being less than 1. The difference between preoperative and postoperative mRS scores was statistically significant (P < 0.01). Six patients experienced temporary postoperative complications, which resolved after active treatment, and one patient developed permanent Horner’s syndrome without affecting the quality of life. Microsurgical surgery for patients with proximal vertebral artery stenosis, when endovascular treatment is unsuitable, demonstrates good clinical efficacy and a low incidence of complications, offering a viable surgical treatment option. Further multicenter studies with larger sample sizes will be instrumental in validating its clinical application value.

Vertebral Artery Stenosis Caused by Cervical Osteophyte: A Rare and Reversible Cause of Vertebrobasilar Insufficiency. Case Report

AbstractBow Hunter syndrome manifests when the vertebral artery is compressed following head rotation. Symptomatic compression with vertebral artery stenosis due to cervical osteophytes is a rare cause and occurs due to a progressive degenerative process. In most cases, compression originates anteromedially from the uncinate process and is asymptomatic due to the competence of the contralateral vertebral artery. In the described patient, compression presented superomedially due to osteophytes in the superior articular facet of the C5 vertebra, and the contralateral vertebral artery was obstructed. Careful evaluation with imaging, mainly preoperative 3D angiotomography, is necessary to determine the most beneficial approach for decompression. The treatment of choice for symptomatic compression induced by cervical spondylosis is decompression surgery.

The Current Status of Endovascular Treatment for Extracranial Vertebral Artery Stenosis in Japan: A Subanalysis of the Japanese Registry of Neuroendovascular Therapy 4.

Endovascular treatment (EVT) is a potential therapeutic option for extracranial vertebral artery (VA) stenosis; however, its efficacy or optimal procedures remain unknown. This study aimed to investigate the recent status of EVT for extracranial VA stenosis in Japan using a nationwide registry. We conducted a post hoc analysis of the Japanese Registry of Neuroendovascular Therapy 4 that enrolled patients who underwent EVT at 166 hospitals in Japan from 2015 to 2019. The outcomes of this study were as follows: procedural success indicating that the planned procedure was completed, modified Rankin Scale (mRS) score at 30 days, and procedure-related complications evaluated according to the procedure during EVT (percutaneous transluminal angioplasty vs. stenting and with or without the use of embolic protection devices [EPDs]). Of 308 eligible patients, 301 (95%) were treated for atherosclerotic stenosis, predominantly by stenting (74%). EPDs were used in 43%, primarily with the distal balloon (63%). The proportion of procedural success was 98%. Functional independence (mRS of 0-2) at 30 days was achieved in 80% of the total cohort, and there were no differences between patients treated with or without stenting or EPDs (74% vs. 82%, p = 0.12, and 80% vs. 80%, p = 0.93). Procedural complications occurred in 28 (9.1%) patients similarly in each group, with distal embolism and vessel dissection being common. In conclusion, EVT is a reasonable option for extracranial VA stenosis as a daily clinical practice. This study emphasizes the potential of EVT in managing extracranial VA stenosis and the need for further research to refine treatment strategies.

Efficacy and safety of drug-eluting stents versus bare-metal stents in symptomatic intracranial and vertebral artery stenosis: a meta-analysis.

This study aims to present the first comprehensive meta-analysis assessing the effectiveness and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in treating intracranial and vertebral artery stenosis. A comprehensive examination was undertaken to compare the effectiveness and safety of DES and BMS in individuals experiencing symptomatic stenosis in the intracranial and vertebral arteries through an in-depth analysis of clinical research. We conducted an extensive search across multiple databases including PubMed, Embase, Web of Science, and the Cochrane Library up to September 2024. The emphasis of our investigation was on various outcomes including rates of in-stent restenosis, symptomatic occurrences of in-stent restenosis, incidence of stroke, procedural success, mortality rates, complications associated with the procedure, and any adverse events. Our analysis included 12 studies with a total of 1,243 patients (562 in the DES group and 681 in the BMS group). The findings demonstrated a significantly lower rate of in-stent restenosis in the DES group for both intracranial [odds ratio (OR): 0.23; 95% confidence interval (CI): 0.13 to 0.41; p < 0.00001] and vertebral artery stenosis (OR: 0.38; 95% CI: 0.20 to 0.72; p = 0.003) compared to the BMS group. Additionally, the DES group showed a significantly reduced rate of postoperative strokes in vertebral artery stenosis cases (OR: 0.38; 95% CI: 0.16 to 0.90; p = 0.03), with no significant differences noted in the intracranial artery stenosis comparison (OR: 0.63; 95% CI: 0.20 to 1.95; p = 0.42). The study also revealed no significant disparities in symptomatic in-stent restenosis, procedural success, mortality, adverse effects, and perioperative complications between the two groups across the conditions studied. The comparison indicates that DES significantly reduces the risk of in-stent restenosis and postoperative strokes in patients with vertebral artery stenosis, compared to BMS. For both intracranial and vertebral artery stenosis, DES and BMS exhibit comparable safety profiles. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=439967.

Bow–Hunter Syndrome Due to Tandem Lesions; A Case Report

AbstractBow–Hunter syndrome (BHS) includes a form of stroke caused by dynamic factors affecting the extracranial vertebral artery (VA), such as rotation-induced flow disturbance at the atlantoaxial level. BHS is a rare condition that can result from a variety of factors, including abnormal bone compression and vertebral instability. So far, there have been no reports in which both vertebral instability and osteophytes compress the VA at different sites, leading to stroke. Herein, we present a rare case of stroke attributed to BHS involving thrombosis formation due to osteophyte compression at C3/4 and VA occlusion due to vertebral instability at the C4/5 overlapped. A 72-year-old male presented with rotational vertigo and vomiting associated with a cerebellar infarction. Digital subtraction angiography revealed severe stenosis of the left VA with an intra-arterial thrombus. Percutaneous transluminal angioplasty improved the stenosis; however, intravascular ultrasound revealed compression of the VA by osteophytes at C3/4. Additionally, left VA occlusion at C4/5 was confirmed because of vertebral instability. The osteophyte was removed via the anterolateral approach, and the VA was decompressed. The patient's postoperative course was uneventful, with no recurrence for more than 2 years. BHS can occur in the lower cervical spine when vertebral instability coincides with intimal arterial damage caused by osteophytes at other sites.

Abstract 458: Utilizing Transcranial Doppler in the Diagnosis of Cervical Artery Dissection: Insights from a Multicenter Survey within the STOP‐CAD Study

Background Cervical artery dissection (CAD) is a common cause of ischemic stroke in young adults. Local blood clot formation and distal emboli are the key mechanisms for the development of stroke in patients with CAD. Microemboli distal to the dissection point can be detected as high‐intensity transient signals (HITS) using Transcranial Doppler (TCD). Despite this unique capability, TCD is used inconsistently in the management of CAD. In this international survey, we aim to explore the frequency and potential barriers to TCD use in CAD. Method This study was an international electronic survey, based on the Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP‐CAD) study, aiming at evaluating the use of TCD in diagnosing and managing CAD patients. A comprehensive questionnaire was developed to gather insights into the current practices, perceptions, and potential barriers to the effective use of TCD in participating centers. The collected data was then analyzed. Results Fifty‐eight medical centers with advanced stroke care capabilities from Europe and United States participated in this study. Half (29 out of 58) of the sites routinely perform TCD on CAD patients, particularly in the presence of carotid or vertebral artery stenosis, complete carotid occlusion, and early neurologic deterioration. The primary reason for participating institutions not performing TCD was because its results would not change their practice. The protocol for TCD monitoring and managing HITS‐positive CAD patients varied among centers but transitioning from antiplatelet to anticoagulant was the most common practice in this patient population. Conclusion Half of the stroke centers in our survey routinely perform TCD monitoring for CAD patients. The detection of HITS in CAD patients is a warning sign for providers, which may prompt a change in secondary stroke prevention management. However, a standard protocol for performing TCD in CAD and treatment recommendations for HITS‐positive CAD are not currently available, which warrants further research.

Abstract 460: Variation Of Bowhunter's Syndrome: Right Vertebral Artery Occlusion From Cervical Disc Herniation ‐ A Case Report

Introduction Bowhunter's syndrome (BHS) occurs when an individual turns their head, often greater than 45 degrees, causing mechanical occlusion of the ipsilateral vertebral artery (VA). Common causes include osteophytes or disc herniations [1]. This dynamic stenosis results in symptoms of vertebrobasilar insufficiency (VBI) such as vertigo, nystagmus, dizziness, and changes in vision and gait [3]. BHS is a rare but curable cause of VBI. Methods/Case Presentation A 59‐year‐old woman with a history of congestive heart failure, hypertension, obstructive sleep apnea, cervical spondylosis, thoracic spondylosis, atherosclerotic cardiovascular disease, hyperlipidemia, and type 2 diabetes mellitus presented with recurrent presyncope, vertigo, and progressive right upper and lower extremity weakness. Her symptoms worsened with head rotation to the right. Cerebral angiogram showed chronic occlusion of the left VA and rotational occlusion of the V2 segment of the right VA, which had 50% baseline occlusion and 80% occlusion with head turned to the right. The stenosis occurred greatest at C3‐4 due to a lateral cervical disc herniation. The patient possessed a small right posterior communicating artery and lacked collateral flow from the left VA. Results She was treated with a C3‐4 anterior cervical discectomy and fusion (ACDF) and skeletonization of right VA with resolution of positional occlusion of the VA. Postoperatively, her dizziness and instability resolved, but she experienced new dysphagia and operative site discomfort. Right extremity weakness persisted with 4/5 muscle strength in the right deltoid, bicep, tricep, wrist extension, grasp, and iliopsoas. Postoperative x‐rays showed good positioning of her C3‐4 interbody graft, anterior cervical plate, and screws. Two months later, a follow‐up cerebral angiogram confirmed resolution of right VA stenosis in all head positions. Conclusion This case provides insights into alternative presentations of BHS. Notably, the right VA was the primary symptomatic vessel, whereas the left VA is historically more affected [2]. More common causes like cervical spine trauma, neoplastic growths, and osteophytes may present with a larger constellation of symptoms that delay diagnosis [4]. A key takeaway is the body's adaptation to changes in head and neck perfusion. In healthy individuals, the contralateral VA compensates for posterior circulation demands [3]. This patient showed a combination of contralateral VA atherosclerosis and a lack of protective collateralization. Conservative management is effective for approximately 75‐90% of cervical spine disc herniations, but the risk of cerebrovascular complications in this patient necessitated surgical intervention [5]. The anterior approach to discectomy has shown better outcomes compared to posterior decompression, with fewer instances of VA injury [6]. Vertebral stenting is an alternative that has historically shown success [7]. However, the risk of stent deformation and fracture in the cervical spine was considered too great. Her persistent right extremity weakness suggests possible secondary etiology or lasting deficits from transient cerebral hypoperfusion. As with any cause of VBI, BHS should be considered as a risk factor for severe cerebrovascular events. This case continues to support digital subtraction angiograms for diagnosis and ACDF for surgical treatment as a successful pathway for those with BHS [6].

Abstract 162: Vertebral Artery Stenting for Compression Stenosis Due to Cervical Facet Hypertrophy

Background Vertebrobasilar insufficiency can be caused by various pathologic conditions including atherosclerosis, dissections, steal phenomenon, etc. While endovascular treatment of those conditions is well‐established, stenting of vertebral artery (VA) compression stenosis due to cervical facet hypertrophy is uncommon. We describe a case of VA stenting to address the symptomatic stenosis caused by mass effect from cervical facet hypertrophy. Method A 78‐year‐old male with a history of deep venous thrombosis and paroxysmal atrial fibrillation presented with several episodes of transient loss of awareness triggered by neck movement from side to side. This has restricted his neck mobility. Computed tomography angiography (CTA) revealed stenosis of the left VA at the C3‐C4 level secondary to cervical facet hypertrophy. Decision was made to treat this problem via endovascular means. Results Access was achieved via the right femoral artery, and a guide catheter was parked in the left subclavian artery just proximal to the left VA ostium. The left VA was selected with an intermediate catheter, and angiography revealed a moderate stenosis at the cervical V2 segment, with no evidence of atherosclerosis nor dissection. 3D rotational angiography confirmed the stenosis being caused by a C3‐C4 facet hypertrophy impinging on the artery. We proceeded with angioplasty and stenting at the point of stenosis, using a balloon‐mounted Papyrus stent. Follow‐up angiography showed improvement in the degree of stenosis. At 1‐month follow‐up, patient was symptom‐free, with no recurrence of his symptoms. Conclusion This case illustrates vertebral stenting a potential therapeutic option for vertebral artery compression stenosis caused by cervical facet hypertrophy. Although residual stenosis remained, the intervention improved the patient's symptoms.

Stenting for symptomatic intracranial arterial stenosis with different qualifying arteries: a preplanned pooled individual patient data analysis

BackgroundThe efficacy of percutaneous transluminal angioplasty and stenting (PTAS) relative to medical management in treating symptomatic intracranial arterial stenosis (ICAS) varies based on the qualifying artery. This study aims to...

Association of Subclavian Steal Phenomenon with Prevalence of Contralateral Vertebral Artery Atherosclerotic Stenosis: A Hospital-Based Cohort Study.

It is uncertain if there is a connection between subclavian steal phenomenon (SSP) and atherosclerotic stenosis in the opposite vertebral artery (VA). We aimed to explore the association between SSP and the incidence of contralateral vertebral artery stenosis (VAS) in vivo. In this prospective registry study, we included patients diagnosed with ＞50% stenosis of proximal subclavian artery (SA) or innominate artery (INA) by digital subtraction angiography (DSA) from our comprehensive stroke center between 2011 and 2022. VAS and SSP was diagnosed by DSA in the resting state. Propensity score matching (PSM) was conducted among all participants and subgroups with a 1:1 ratio according to the presence of SSP. We further conducted sensitivity analysis by dividing all participants into subgroups according to the degree of stenosis and type of SSP. Binomial logistic regression analysis was applied to investigate the association of SSP with contralateral VAS. A total of 774 patients were included in this study and 309 (39.9%) were found with SSP. After PSM, presence of SSP was associated with lower prevalence of contralateral VAS among all participants (OR 0.45; 95% CI 0.31-0.65; p＜0.001). In subgroup analysis, the association was respectively found within left subclavian (LSA) stenosis group (OR 0.43; 95% CI 0.29-0.65; P＜0.001) and right subclavian artery (RSA) / INA stenosis group (OR 0.36; 95% CI 0.19-0.69; P=0.002). SSP is associated with lower prevalence of contralateral VAS.

Indications, operative techniques, and outcomes of occipital artery-vertebral artery bypass: an institutional series.

Posterior circulation cerebral bypasses often show higher risks and lower patency. Only few reports discussed occipital artery (OA)-vertebral artery (VA) bypasses. We present our illustrative cases to address current gaps in the literature on OA-VA bypass. A single-center retrospective review was conducted to include all institutional cases of OA-VA bypass, discussing the technique and outcomes. Four institutional cases undergoing a total of 5 bypasses were evaluated, including 3 males and 1 female, with median age of 65years (range, 62-73). All patients had vertebrobasilar insufficiency (VBI) with recurrent strokes/TIAs due to intracranial atherosclerosis, leading to unilateral VA stenosis with contralateral occlusion (1, 25%), bilateral VA stenosis (1, 25%) or occlusion (1, 25%). Medical management included aspirin for all cases (100%), with clopidogrel in 3 (75%). Surgery was performed through a far lateral approach, connecting the OA to the VA-3 segment, with no inter-positional graft. One patient underwent contralateral OA-VA bypass 6months after the prior surgery due to worsening of the contralateral VA stenosis. Bypass patency was confirmed in all cases with post-operative angiography. All patients had clinical improvement, with one case of wound dehiscence managed conservatively. All patients were alive at last follow-up (median 7.0months; range: 1.5-18). OA-VA bypass is a challenging yet effective strategy in selected patients with VBI. Current literature lacks unique definitions of surgical indications and techniques, which we addressed in our series. Surgical education should focus on expanding the microsurgery anatomy knowledge.

Carotid artery stenosis is related to cerebral small vessel disease magnetic resonance imaging burden

BackgroundCerebral small vessel disease (CSVD) encompasses conditions that affect small blood vessels of the brain, the most common being atherosclerosis. Magnetic resonance imaging (MRI) CSVD markers include lacunar strokes (LS), white matter hyperintensities (WMH), microbleeds, enlarged perivascular spaces (EPVS), and brain atrophy. Large and small cerebral arteries share an anatomical and functional connection, but the role of large vessel atherosclerosis in atherosclerotic CSVD hasn't been established. The aim of this study was to evaluate the involvement of large vessel pathology in atherosclerotic CSVD. MethodsThis cross-sectional study included 98 patients treated at the Neurology Clinic of the University Clinical Center of Serbia in Belgrade, from February 2018 to December 2023, who had atherosclerotic CSVD confirmed by neuroimaging and underwent extracranial color duplex sonography. Data on patients’ gender, age, cerebrovascular risk factors (dyslipidemia, hypertension, diabetes mellitus, smoking status), ultrasonography findings (intima-media thickness - IMT, carotid and vertebral artery stenosis, and hemodynamics), and CSVD imaging markers were collected, and the CSVD MRI burden score was calculated. ResultsAge correlated with LS and WMH (p < 0.05 for both). Hypertension correlated with WMH (p = 0.016), and smoking with LS (p = 0.043). Brain atrophy was more common in women (p = 0.016). The majority of patients had low-grade (<50 %) carotid stenosis. There was a strong correlation between all morphological parameters of internal carotid artery stenosis and the CSVD burden score (p < 0.05 for all). The hemodynamic parameters of internal carotid artery stenosis and morphological and hemodynamic parameters of vertebral artery stenosis didn't correlate with the CSVD burden score. ConclusionsThis study shows a strong correlation between cerebral large and small vessel pathology. We recommend the use of extracranial color duplex sonography in the evaluation of patients with CSVD as a supplementary method for follow-up, as this would allow the identification of patients whose condition might progress.

Weaning failure due to isolated residual diaphragmatic paralysis after cervical spinal cord ischemia following aortic surgery- a case report

BackgroundBilateral diaphragmatic dysfunction can lead to dyspnea and recurrent respiratory failure. In rare cases, it may result from high cervical spinal cord ischemia (SCI) due to anterior spinal artery syndrome (ASAS). We present a case of a patient experiencing persistent isolated diaphragmatic paralysis after SCI at level C3/C4 following thoracic endovascular aortic repair (TEVAR) for Kommerell’s diverticulum. This is, to our knowledge, the first documented instance of a patient fully recovering from tetraplegia due to SCI while still exhibiting ongoing bilateral diaphragmatic paralysis.Case presentationThe patient, a 67-year-old male, presented to the Vascular Surgery Department for surgical treatment of symptomatic Kommerell’s diverticulum in an aberrant right subclavian artery. After successful surgery in two stages, the patient presented with respiratory insufficiency and flaccid tetraparesis consistent with anterior spinal artery syndrome with maintained sensibility of all extremities. A computerized tomography scan (CT) revealed a high-grade origin stenosis of the left vertebral artery, which was treated by angioplasty and balloon-expandable stenting. Consecutively, the tetraparesis immediately resolved, but weaning remained unsuccessful requiring tracheostomy. Abdominal ultrasound revealed a residual bilateral diaphragmatic paralysis. A repeated magnetic resonance imaging (MRI) 14 days after vertebral artery angioplasty confirmed SCI at level C3/C4. The patient was transferred to a pulmonary clinic with weaning center for further recovery.ConclusionsThis novel case highlights the need to consider diaphragmatic paralysis due to SCI as a cause of respiratory failure in patients following aortic surgery. Diaphragmatic paralysis may remain as an isolated residual in these patients.

Bow hunter’s syndrome due to an anomalous right vertebral artery origin and contralateral absence: a case report and literature review

BackgroundBow Hunter’s syndrome (BHS), also known as rotational vertebral artery occlusion (RVAO), is a rare condition characterized by dynamic vertebrobasilar insufficiency due to position-dependent occlusion of the vertebral artery (VA). In the existing literature, most cases of BHS are attributed to osteophytic compression originating from the occipital condyle or within the transverse foramen, often accompanied by anatomical abnormalities of the VA. However, cases presenting solely with VA anomalies in the absence of any cervical vertebral structural abnormality are rare. This case report presents a unique instance of BHS in a 56-year-old male, attributed to the anomalous origin of the right VA and the absence of the left VA, without cervical structural abnormalities.Case presentationThe patient exhibited symptoms like episodic dizziness and vertigo, which were exacerbated by rightward head rotation and alleviated upon returning to a neutral position. Diagnostic evaluation, including digital subtraction angiography, revealed that the right VA originated from the right common carotid artery and compression-induced stenosis of the right VA during head rotation. Conservative management, including avoidance of certain head movements and anti-arteriosclerosis medication, led to symptom resolution over a two-year follow-up period.ConclusionsThis report contributes to the understanding of BHS by highlighting a rare vascular anomaly presentation and incorporates a review of 14 similar case reports in the literature describing that an anatomical abnormality of the VA is mainly responsible for the pathology of BHS in the absence of cervical vertebral anomalies, thus emphasizing the need for careful diagnostic and management strategies.

An analysis of clinical characteristics of rare bilateral medial medullary infarction: An observational study.

This study aimed to characterize the risk factors, etiology, clinical manifestations, anatomical characteristics, stroke mechanisms, imaging features, and prognosis of bilateral medial medullary infarction (BMMI). A retrospective analysis was conducted on 11 patients with BMMI who met the inclusion criteria at the Affiliated Hospital of Xuzhou Medical University from January 2013 to January 2023. The patients' imaging and clinical features were analyzed and summarized. Eleven patients (7 male, 4 female), aged 46 to 62 years, met the inclusion criteria. Common clinical presentations included dysarthria (90.9%), dysphagia (90.9%), quadriplegia (81.8%), and so on. Within 72 hours of onset, 8 cases presented with quadriplegia, 2 cases with hemiplegia, and 1 case without limb paralysis. The main risk factor for BMMI was hypertension, followed by diabetes. "Heart appearance" infarcts occurred in 4 cases (36.4%), while "Y appearance" infarcts occurred in 7 cases (63.6%). Among the patients, 3 had unilateral vertebral artery stenosis or occlusion, 5 had bilateral vertebral artery stenosis or occlusion, 2 had normal vertebral basilar artery, and 1 did not undergo cerebrovascular examination. All patients received standardized treatment for cerebral infarction. The prognosis was poor, with 81.8% of patients having an unfavorable outcome, including 1 death, 9 cases of disability, and only 1 patient achieving self-care ability after recovery. BMMI is more prevalent in males aged 45 to 60 years. The main risk factors are hypertension and diabetes. Atherosclerosis is the primary etiological subtype. The main clinical manifestations are dyskinesia, dizziness, quadriplegia, and dysarthria. The prognosis of BMMI is poor. The specific imaging features of "heart appearance" or "Y appearance" infarcts aid in the diagnosis of BMMI.

Impact of qualifying artery on the efficacy of stenting plus medical therapy versus medical therapy alone in patients with symptomatic intracranial stenosis: a post-hoc analysis of the CASSISS trial

BackgroundA recent trial failed to show any benefit of stenting plus medical therapy over medical therapy alone in patients with symptomatic intracranial stenosis. We aimed to examine whether the symptomatic...

Retrospective Cohort Angiographic Analysis of Vertebral Artery Dominance, Stenosis Patterns, and Demographic Correlations.

Differences in dominance and stenosis in the complex vertebral artery (VA) network pose challenges in diagnosing and treating cerebrovascular diseases crucial for brain nutrition. This research examines these intricacies, highlighting the importance of detailed diagnosis and treatment methods. To analyze the prevalence of the dominant VA, evaluate the influence of gender and age on steno-occlusion, and explore the correlation between the dominant VA and stenosed VA segments. A retrospective study of 249 angiograms from patients with VA stenosed at King Abdullah University Hospital between August 2019 and December 2022. The patients presenting symptoms of vertigo, migraines, headaches, or transient ischemic attacks (TIA) were included, 182 cases were classified based on VA dominance and stenosis severity. The data were analyzed using IBM SPSS 27. Out of the 182 participants, 64.8% were male, with an average age of 61.3 years and 35.2% were female. The prevalence of stenosis was distributed as follows: 26.4% mild, 44.0% moderate, and 29.7% severe. Statistically significant correlations were observed between hypertension, smoking, hyperlipidemia, and the degree of stenosis (p < 0.05), but not with diabetes. The prevalence of left vertebral artery (VA) dominance was found to be 41.1%. Additionally, there was no gender connection observed in the distribution of steno-occlusion (p = 0.434). There is no notable correlation between the degree of stenosis and the dominant vertebral artery (p > 0.05). Angiographic findings reveal the complex relationship between the dominance of the VA, patterns of stenosis, and demographic factors. Individuals with a dominant VA had a greater likelihood of developing stenosis on the opposite non-dominant side. The high occurrence of severe stenosis highlights the need for tailored diagnostic and treatment approaches. Understanding vertebral stenosis as a multifaceted interaction of demographic, lifestyle, and anatomical variables is essential for enhancing treatment strategies.

Comparison of Vertebral Artery Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography in the Diagnosis of Vertebral Artery Stenosis in Patients with Posterior Circulation Ischemia

Comparison of Vertebral Artery Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography in the Diagnosis of Vertebral Artery Stenosis in Patients with Posterior Circulation Ischemia

Application of transcranial Doppler in the diagnosis and management of cervical artery dissection: Insights from a multicenter survey within the STOP‐CAD study

AbstractBackgroundCervical artery dissection (CAD) is a common cause of ischemic stroke in young adults. Local blood clot formation and distal emboli are the key mechanisms for the development of stroke in patients with CAD. Microemboli distal to the dissection point can be detected as high‐intensity transient signals (HITS) using transcranial Doppler (TCD). Despite this unique capability, TCD is used inconsistently in the management of CAD. In this international survey, we aim to explore the frequency and potential barriers to TCD use in CAD.MethodThis study was an international electronic survey, based on the Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP‐CAD) study, aiming at evaluating the use of TCD in diagnosing and managing CAD patients. A comprehensive questionnaire was developed to gather insights into the current practices, perceptions, and potential barriers to the effective use of TCD in participating centers. The collected data was then analyzed.ResultsFifty‐eight medical centers with advanced stroke care capabilities from Europe and United States participated in this study. Half (29 out of 58) of the sites routinely perform TCD on CAD patients, particularly in the presence of carotid or vertebral artery stenosis, complete carotid occlusion, and early neurologic deterioration. The primary reason for participating institutions not performing TCD was because its results would not change their practice. The protocol for TCD monitoring and managing HITS‐positive CAD patients varied among centers but transitioning from antiplatelet to anticoagulant was the most common practice in this patient population.ConclusionHalf of the stroke centers in our survey routinely perform TCD monitoring for CAD patients. The detection of HITS in CAD patients is a warning sign for providers, which may prompt a change in secondary stroke prevention management. However, a standard protocol for performing TCD in CAD and treatment recommendations for HITS‐positive CAD are not currently available, which warrants further research.