Vertebrobasilar Artery Disease Research Articles

A balloon-supported embolism protection technique during vertebral/subclavian artery angioplasty stenting.

A balloon-supported embolism protection technique during vertebral/subclavian artery angioplasty stenting.

Limb shaking transient ischemic attacks: A follow-up of 28 patients

BackgroundLimb shaking transient ischemic attack (LSTIA) is an uncommon picture of carotid-occlusive disease. The symptoms are a seizure like activity and misdiagnosed as partial motor seizures. We here present a series of patients in our registry who had limb-shaking activities and their long-term outcome after treatment of their disease. MethodsA total of 28 patients with limb shaking symptoms were recruited among 798 patients with TIA in our stroke registry. Risk factors and etiology of LSTIA were examined within hospitalization. After the initiaition of treatment patients were followed for a median of 6months. ResultsLimb-shaking was observed mainly on the hand-arms (46%), and secondly on the legs (39%). We found five different DWI lesion patterns in patients with LSTIA, including unilateral or bilateral either cortical or borderzone ischemic hyperintensities. Carotid endarterectomy was performed in 9 (32%) patients and carotid angioplasty-stent (CAS) in 10 (36%), and after 6-months of follow-up none of the patients had LSTIA. Limb shaking continued only in a patient with chronic carotid occlusion who received only conservative treatment. ConclusionsLimb shaking TIA point to carotid artery disease in the majority of patients and vertebrobasilar artery disease in one third. Fast and timely treatment with either surgical or CAS eliminates the attacks and also reduce their risk of stroke.

Hemodynamic alterations in vertebrobasilar large artery disease assessed by arterial spin-labeling MR imaging.

VB artery stenosis is associated with a high risk of recurrent ischemic events, and knowledge about the hemodynamic relevance of VB stenosis is important for clinical decision making. In this study, multiple inflow pulsed ASL MR imaging was assessed for its ability to measure CBF and ATT in patients with VB disease. ASL was performed on a 3T MR imaging scanner in 41 participants. Twenty-one patients had a history of ischemic events in the VB circulation (14 men, 7 women, age 66 ± 11 years). Clinical data and CE-MRA were used to classify VB disease severity. Twenty age-matched adults were controls. Group and within-VB analyses were performed. Mean CBF and ATT values in the ROIs were adjusted by excluding voxels that did not produce a reliable ASL estimate. CBF was reduced (P < .003) in patients compared with controls, which was significant after excluding voxels with a poor fit. Differences in ATT between patients and controls were not significant after voxel correction. There was a strong correlation between CBF and ATT among patients. Finally, ATT was significantly correlated with VB disease severity (P = .026). Multiple inflow ASL distinguished patients with VB disease from age matched-controls. VB disease rating was associated with prolonged ATT downstream. ASL may have diagnostic potential among patients in whom risk of intervention is high.

Bilateral vertebral artery disease: Transcranial Doppler assessment of the hemodynamic vulnerability to changes in posture

Posture changes may cause hemodynamic ischemic events, particularly in severe vertebrobasilar artery disease. It may be difficult and not without risk to prove this vulnerability to changes in posture during angiography. Therefore, TCD monitoring with passive tilting (PT) was used to evaluate cerebral hemodynamics distally to severe bilateral vertebral artery disease (BVAD). PCA flow velocity changes and dynamic cerebral autoregulation (DCA) were analyzed in supine and upright position. Despite a significant autoregulatory deficit distally to BVAD, the posterior cerebral blood supply seemed to be sufficiently maintained as long as systemic blood pressure changes were within normal limits. Posterior cerebral flow velocities, however, were significantly diminished when PT detected a systemic hypotension in upright position. This study proves the feasibility to combine PT and TCD monitoring of the PCA in patients with BVAD. In vertebrobasilar artery disease, the examination of spontaneous and tilt-induced autoregulatory responses could support the evaluation of a risk for hemodynamic ischemia. (E-mail: christina.haubrich@t-online.de)

Lesion patterns and etiology of ischemia in the anterior inferior cerebellar artery territory involvement: a clinical – diffusion weighted – MRI study

The topography and mechanism of stroke in the anterior inferior cerebellar artery (AICA) territory are delineated before, but the detailed clinical spectrum of lesions involving AICA territory was not studied by diffusion weighted imaging (DWI). We reviewed 1350 patients with posterior circulation ischemic stroke in our registry. We included patients if the diagnosis of AICA territory involvement was confirmed, and DWI, and magnetic resonance angiography were obtained in the 3 days of symptoms onset. The potential feeding arteries of the AICA territory were evaluated on magnetic resonance imaging (MRI) using a three-dimensional rotating cineoangiographic method. There were 23 consecutive patients with lesion involving AICA territory, six with isolated lesion in the AICA territory, six with posterior inferior cerebellar artery, 11 with multiple posterior circulation infarcts (MPCIs). The clinical feature of isolated AICA infarct was vertigo, tinnitus, dysmetria, ataxia, facial weakness, facial sensory deficits, lateral gaze palsy, and sensory-motor deficits in patients with pontine involvement. Patients with largest lesion extending to the anterior and inferolateral cerebellum showed mixed symptomatology of the lateral medullary (Wallenberg's syndrome) and AICA territory involvement. Patients with MPCIs presented various clinical pictures with consciousness disturbances and diverse clinical signs because of involvement of different anatomical structures. Large-artery atherosclerotic disease in the vertebrobasilar system was the main cause of stroke in 12 (52%) patients, cardioembolism (CE) in one (4%), and coexisting large-artery disease and a source of CE in four (17%). The main cause of stroke was atheromatous vertebrobasilar artery disease either in the distal vertebral or proximal basilar artery. The outcome was usually good except those with multiple lesions. The new MRI techniques and clinical correlations allow better definition of the diverse topographical and etiological spectrum of AICA territory involvement and associated infarcts which was previously based on pathological and conventional MRI studies.

Vertebrobasilar arterial occlusive disease, medical and surgical management Ramon Berguer, Raymond B. Bauer. 240 × 160 mm. Pp. 336 + xvi. Illustrated. 1983. New York: Raven Press. $56.00

Vertebrobasilar arterial occlusive disease, medical and surgical management Ramon Berguer, Raymond B. Bauer. 240 × 160 mm. Pp. 336 + xvi. Illustrated. 1983. New York: Raven Press. $56.00 Get access Vertebrobasilar Arterial Occlusive Disease, Medical and Surgical ManagementRamon Berguer, Raymond B Bauer. 240 × 160 mm. Pp. 336 + xvi. Illustrated. 1983. New York: Raven Press. $56.00. J S P Lumley J S P Lumley Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 71, Issue 11, November 1984, Pages 918–919, https://doi.org/10.1002/bjs.1800711142 Published: 07 December 2005

Diffusion-Weighted Magnetic Resonance Imaging in Symptomatic Vertebrobasilar Atherosclerosis and Dissection

Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail. To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia. Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease. Large community-based teaching hospital. Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset. Infarct patterns were analyzed according to established templates of vascular territories. Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P = .48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (37%) of 11 patients with dissections (P = .6). Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.

Lesion Patterns and Etiology of Ischemia in Superior Cerebellar Artery Territory Infarcts

Background and Purpose: Infarcts in the territory of superior cerebellar artery (SCA) are uncommon. The clinical, and etiological mechanisms of different infarct patterns of SCA are not well known. Diffusion-weighted imaging (DWI) is superior to conventional magnetic resonance imaging for detecting acute small and multiple ischemic lesions. Methods: We studied 60 patients with lesions involving SCA territory proved by DWI, which have been selected from 3,800 patients with first ischemic stroke consecutively admitted to our stroke unit over a period of 5 years. Results: There are 7 distinctive SCA lesion patterns: (1) a lesion was found in the medial (m) branch territory of SCA (mSCA) in 14 patients; (2) a lesion in the lateral (l) branch territory of SCA (lSCA) was seen in 9 patients; (3) a coexisting lesion involving mSCA and lSCA was found in 9 patients; (4) a lesion in cortical borderzones between SCA and m/l branches of the posterior inferior cerebellar artery (PICA) was observed in 6 patients; (5) a lesion in deep borderzones between lSCA and mSCA, and lPICA and mPICA was present in 8 patients; (6) a lesion involving the medial rostral cerebellum between the right and left SCA was found in 4 patients; (7) multiple lesions involving SCA and other vertebrobasilar artery territories were present in 10 patients. The main cause was possible artery-to-artery embolism from atherosclerotic vertebrobasilar arteries to distal branches of SCA in 20 patients (33%). Fourteen patients had a source of cardioembolism (23%), and 6 patients (8%) had concomitant atherosclerotic vertebrobasilar artery disease and a source of cardioembolism. Conclusions: An acute ischemic lesion in the SCA territory is mainly multiple. The lSCA territory was the most involved area. Small territorial infarcts were frequently associated with large territorial SCA infarcts. Borderzone SCA infarcts occurred in one third of the patients with transient benign symptoms. Mass effects are unusual despite the large amount of SCA involvement. Our results supported the fact that embolism is the predominant stroke mechanism in the SCA territory infarction.

Vestibular Neuronal Function of Cats Following Unilateral Vertebral Artery Occlusion

Since vertigo is known to be caused by vertebrobasilar arterial occlusive disease (ex. vertebrobasilar insufficiency; VBI), an electrophysiological study was performed to examine the effects of a unilateral vertebral artery (VA) occlusion on the neuronal activities of the medial vestibular nucleus (MVN) and vestibular ganglion (VG) in f -chloralose-anesthetized cats. Single neuronal activity in the MVN and VG was recorded extracellularly with a glass-insulated silver wire microelectrode. When the unilateral VA was occluded for 5 min, the spontaneous firing rate in the MVN was altered as follows. The type A pattern exhibited a transient increase, followed by a decrease. The type B pattern showed a gradual decrease, and no further changes after the onset of occlusion. Type A and B patterns were observed respectively in MVN ipsi- and contra-lateral to the VA occlusion. In contrast, the VG neuronal firing rate was not affected by the occlusion. These results seem to support the clinical suggestion that the vertigo in VBI is produced by a difference in the function between the bilateral vestibular nuclei, rather than by the peripheral vestibular nerve.

Vertebrobasilar insufficiency: correlation of clinical and radiologic findings.

Radiological and clinical findings of 20 cases with angiographically proven stenosis or occlusion of the vertebrobasilar system and with clinical signs and symptoms attributable to posterior circulation disorder were studied. A simplified classification of vertebrobasilar arterial disease was presented; type I refers to stenosis of the vertebrobasilar system or subclavian artery, type II refers to vertebrobasilar occlusion, and type III refers to vertebrobasilar branch disease. Type I lesions were further subdivided into types Ia and Ib; type Ia cases showed no infarction in the posterior territory, whereas type Ib cases showed one or more infarctions on computed tomography or magnetic resonance imaging. This angiographic classification is based on treatment options that can be adopted to specific types of lesion. In type I cases, lesions are usually amenable to surgical or angiographic intervention. In type II cases, short-term anticoagulation is the treatment of choice. In type III cases, treatment is primarily aimed at prevention of complication and further stroke.

Magnetic resonance angiography in vertebrobasilar ischemia.

Magnetic resonance angiography is a new, noninvasive technique whose diagnostic value in vertebrobasilar artery disease has not yet been determined. Forty-one patients with acute cerebellar and/or brain-stem ischemia were examined by routine magnetic resonance imaging, extracranial and transcranial Doppler ultrasound, and selective intra-arterial arteriography. Results were correlated with magnetic resonance angiography. Magnetic resonance angiography was accomplished using a three-dimensional time-of-flight gradient-echo technique. Magnetic resonance angiography correctly identified all occlusions, stenoses, and an aneurysm within the distal vertebrobasilar system as revealed by conventional intra-arterial arteriography but missed the diagnosis of vertebral artery dissection in one case. This results in a sensitivity of magnetic resonance angiography of 97% and a specificity of 98.9%. However, the degree of stenoses was difficult to evaluate by magnetic resonance angiography. At least for severe obstructive lesions, this drawback can be eliminated by application of presaturation pulses, which allow the analysis of flow direction and collateral blood flow. Doppler ultrasound studies add useful hemodynamic information for less severe degrees of stenoses. The combined use of magnetic resonance angiography and Doppler ultrasound findings may replace the invasive intra-arterial arteriography examination in many patients with suspected macroangiopathy of the vertebrobasilar arteries.

Vertebrobasilar Arterial Occlusive Disease

Vertebrobasilar Arterial Occlusive Disease

Vertebrobasilar Arterial Occlusive Disease: Medical and Surgical Management

A considerable amount of literature exists regarding the importance of carotid artery disease in the production of cerebral ischemia, with much less attention being focused on arterial occlusive disease of the vertebral arteries. The reasons for these discrepancies are probably related to the seemingly vague symptoms associated with vertebrobasilar insufficiency (VBI), the lack of noninvasive evaluative methods, and the difficulty in revascularizing distal vertebral artery occlusions. A more important question, however, is whether the identification and surgical treatment of these lesions improve symptoms and stroke-free survival. This book answers many of these questions and gives a timely update of current diagnostic and surgical modalities for the treatment of VBI. The book consists of 27 reports presented at the first International Conference on Vertebrobasilar Occlusive Vascular Disease in 1982. The reports vary greatly in quality, although the surgical input is outstanding with good illustrations, narrative descriptions, and operative results. However, the

Vertebrobasilar Arterial Occlusive Disease: Medical and Surgical Management

Vertebrobasilar Arterial Occlusive Disease: Medical and Surgical Management

Sudden deafness associated with bilateral Reissner's membrane ruptures

A histologic study of sudden deafness resulting from rupture of cochlear membranes, first in the left ear, and then, three years later, in the right ear, in a patient with vertebro-basilar arteriosclerosis is reported. Two healed ruptures were demonstrated on the right side, one in the hook portion of the cochlea, and one in the area of the promontory. The latter was adherent to the saccule, distorting it inferiorly. In the left temporal bone, a healed rupture was demonstrated approximately 5 mm distal to the labyrinthectomy obliteration. Although the patient's vertebro-basilar artery disease and her sudden deafness syndromes are considered separate entities, one must at least consider whether such longstanding vascular insufficiency might predispose to more readily ruptured membranes with sudden pressure changes in the inner ear.

Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction.

Records of 37 consecutive patients with acute brain infarction from vertebrobasilar artery disease, admitted to the cerebrovascular hospital service within 36 hours of the onset of symptoms, were studied to define the temporal profile of clinical events during the first week of illness. A stable course with unchanged neurologic deficit was found in 11% (4 patients). Progressive improvement in symptoms occurred in 35% (13 patients). Progressive disability occurred in 43% (16 patients). A remitting-relapsing course was noted in 11% (4 patients). In these latter 2 groups, stabilization of the clinical course occurred in the majority with 48 hours after the initial symptom; however, definite changes continued to develop up to 96 hours in a significant number of patients. Mortality at the conclusion of the first week was 27% for the entire group. This was 2.5 times greater than the 10.6% previously reported for a group of 179 patients with acute brain infarction due to carotid system disease who were concomitantly studied.

The Radionuclide Cerebral Angiogram in Stroke Diagnosis

The radionuclide cerebral angiogram using intravenous radiopertechnetate has been found to be of value in confirming the early diagnosis of stroke. The isotopic perfusion study is of value in detecting ischemic carotid and middle cerebral lesions. It can also provide a rapid means of demonstrating intracerebral hemorrhages. Nuclear angiography is not recommended for detection of vertebrobasilar artery disease unless a posterior cerebral artery occlusion is suspected.

Role of cerebral angiography in vertebrobasilar occlusive disease.

The authors attempt to separate clinical subgroups of patients within the larger category of vertebrobasilar artery disease, and to indicate the present role of angiography in their recognition and management. Angiography is of use in separating posterior fossa occlusive vascular lesions from space occupying lesions. In addition, by defining the locus and nature of the occlusive process, it may result in more rational treatment and prognostication. Subgroups of vertebrobasilar ischaemia which have a favourable prognosis may be separable clinically or, in unclear cases, angiographically.

Occlusive vertebrobasilar artery disease associated with cervical spine anomaly.

A 6-year-old boy developed a flaccid hemiplegia and dysarthria following several transient episodes of nausea, vomiting, and ataxia. An anomly of the dens was discovered, permitting subluxation of C-1 on C-2. A segmental occlusion of the right vertebral artery and an aneurysm of the left vertebral artery were found at the C-2 level, as well as a thromboembolic occlusion of the rostral end of the basilar artery. It appeared that the repeated cervical subluxation produced occlusive, aneurysmal, and embolic vascular disease, and that clinical symptoms were the result of ischemia in the territory perfused by the vertebrobasilar arteries.

Evaluation of carotid artery compression in cerebrovascular disease. An electroencephalographic-clinical correlation.

CAROTID artery compression as an aid in evaluating cerebral circulation had been occasionally reported for many years. Only during the last decade, however, was this maneuver performed under electroencephalographic (EEG) control. 1-3 Most reports of the carotid compression test on patients with cerebrovascular disease included relatively small numbers, and the results were variable, even in the few studies of larger groups. 4-9 Little mention has been made of the test's value in determining the site of cerebrovascular disease. Determination of the site of vascular stenosis or occlusion causing cerebral infarction is no longer academic, for arterial surgery or anticoagulant therapy may be indicated in carotid artery or vertebrobasilar artery disease. This study was an attempt to determine the usefulness of the carotid compression test in identifying the site of significant arterial disease. Carotid compression of normal adults rarely evokes change in the EEG. Meyer et al 4 found