Effect of evaluation of vertebrobasilar artery atherosclerosis on the progress of posterior circulation ischemia with high-resolution magnetic resonance imaging / 中国脑血管病杂志

Objective To investigate the value of evaluating vertebrobasilar artery atherosclerosis with 3.0 T high-resolution magnetic resonance imaging (HR-MRI) in the progress of posterior circulation transient cerebral ischemia (TIA).Methods From July 2013 to July 2014,30 consecutive patients (outpatients and inpatients) with posterior circulation TIA at the Department of Neurology,the First People's Hospital of Changshu were enrolled respectively.They were all confirmed as the presence of vertebrobasilar atherosclerotic plaques by the head magnetic resonance angiography.The vertebrobasilar artery plaques were examined with 3 T HR-MRI to assess the nature and stability of the plaques.They were randomly divided into either a stable plaque group (n =16) or an unstable plaque group (n =14) according to the results of plaque stability.They were followed up for 24 months.The time and proportion from the first visit to the posterior circulation infarction were recorded and compared between the two groups of patients.Results At the end of follow-up,the time of posterior circulation infarction in the unstable group was significantly shorter than that in the stable group,and the difference was statistically significant (11.5 [7.0,20.0] months vs.24.0[22.5,24.0] months,Z =-2.755,P ＜ 0.05).The ratios of posterior circulation infarction in the stable group and the unstable group were 5/16 and 8/14 respectively.The difference was not statistically significant between the two groups (P ＞ 0.05).Conclusion Evaluating the results of vertebrobasilar artery atherosclerosis plaque with HR-MRI has a certain value for the progression of posterior circulation ischemia disease.

Application of Vaso CT in the recanalization of vertebrobasilar junction occlusion / 中国脑血管病杂志

Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.

Application of Vaso CT in the recanalization of vertebrobasilar junction occlusion / 中国脑血管病杂志

Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.

Treatment of vertebrobasilar aneurysms using suboccipital muscle stratification via far lateral approach / 中国脑血管病杂志

Objective To discuss the technical essentials of microsurgery using suboccipital muscle stratification for the treatment of complex vertebrobasilar aneurysms via far lateral approach.Methods The clinical data of 8 patients with vertebrobasilar aneurysm underwent suboccipital muscle stratification via far lateral approach at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 5 patients with subarachnoid hemorrhage (Hunt-Hess grade Ⅱ 3 cases;grade Ⅲ 1 case;grade Ⅳ 1 case),and 3 with symptomatic dissecting aneurysm.Six patients underwent occipital artery-posterior inferior cerebellar artery and anterior inferior cerebellar artery bypass grafting,and aneurysm trapping,and the aneurysms of the other 2 cases were clipped directly in the operation.The modified Rankin scale (mRS) was used to evaluate the clinical efficacy.Results Postoperative digital subtraction angiography (DSA) revealed that all the bridge vessels were patent.The obtained length of occipital artery in the actual measurement of the operation was 12.5±1.1 cm.The distance between the anastomosis site and the skin incision in 6 cases was 50±6 mm.They were followed up for 4-21 months after procedure.The mRs score in 7 cases was 0-1.Two patients had new-onset hoarseness and recovered completely within 3 months after procedure.Another patient had postoperative cerebellar hemisphere dominant regional cerebral infarction and the mRs score was 4.None of them had poor wound healing,infection and cerebrospinal fluid leakage after procedure.Conclusion Suboccipital muscle stratification via far lateral approach can effectively obtain a longer occipital artery,reduce the occupation effect of muscle and depth of field.It is beneficial to expose lesions and operation of deep anastomosis.It is a more safe and practical technique in neurosurgery for the treatment of vertebrobasilar artery aneurysms.

The Effectiveness of Additional Treatment Modalities after the Failure of Recanalization by Thrombectomy Alone in Acute Vertebrobasilar Arterial Occlusion

OBJECTIVE: Acute vertebrobasilar artery occlusion (AVBAO) is a devastating disease with a high mortality rate. One of the most important factors affecting favorable clinical outcome is early recanalization. Mechanical thrombectomy is an emerging treatment strategy for achieving a high recanalization rates. However, thrombectomy alone can be insufficient to complete recanalization, especially for acute stroke involving large artery atheromatous disease. The purpose of this study is to investigate the safety and efficacy of mechanical thrombectomy in AVBAO. METHODS: Fourteen consecutive patients with AVBAO were treated with mechanical thrombectomy. Additional multimodal treatments were intra-arterial (IA) thrombolysis, balloon angioplasty, or permanent stent placement. Recanalization by thrombectomy alone and multimodal treatments were assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcome was determined using the National Institutes of Health Stroke Scale (NIHSS) at 7 days and the modified Rankin Scale (mRS) at 3 months. RESULTS: Thrombectomy alone and multimodal treatments were performed in 10 patients (71.4%) and 4 patients (28.6%), respectively. Successful recanalization (TICI 2b-3) was achieved in 11 (78.6%). Among these 11 patients, 3 (27.3%) underwent multimodal treatment due to underlying atherosclerotic stenosis. Ten (71.4%) of the 14 showed NIHSS score improvement of >10. Overall mortality was 3 (21.4%) of 14. CONCLUSION: We suggest that mechanical thrombectomy is safe and effective for improving recanalization rates in AVBAO, with low complication rates. Also, in carefully selected patients after the failure of recanalization by thrombectomy alone, additional multimodal treatment such as IA thrombolysis, balloons, or stents can be needed to achieve successful recanalization.

Treatment of symptomatic vertebrobasilar artery stenosis with stent-assistant angioplasty in the elderly

OBJECTIVE: To study the efficacy, safety, and feasibility of stent-assistant angioplasty (SAA) in the treatment of symptomatic vertebrobasilar artery stenosis in the elderly. METHODS: SAA was performed in 26 elderly patients with symptomatic vertebrobasilar artery stenosis. The success rate, perioperative complications, and long-term effectiveness were evaluated. RESULTS: A total of 29 balloon expandable stents were implanted in these patients. The success ratio was 100%. The degree of stenosis decreased from 81.3 ± 8.8% to 3.7 ± 3.6% (p < 0.01). Complications were absent during the perioperative period. Follow-up was performed for seven to 36 months (median: 21.9 months). Two patients developed the recurrent symptoms of vertebrobasilar artery stenosis, and no cerebral ischemic events were noted in the remaining patients, suggesting a favorable outcome. CONCLUSION: SAA is a safe and effective strategy for the treatment of symptomatic vertebrobasilar artery stenosis in the elderly.

Intracranial stent overlaping in the treatment of unruptured vertebrobasilar dissecting aneurysms / 中国脑血管病杂志

Objective: To investigate the clinical effect and follow-up outcome of the intracranial stent overlapping technique in the treatment of unruptured vertebrobasilar dissecting aneurysms (VBDAs). Methods: Ten patients with VBDAs had 12 unruptured VBDAs were analyzed retrospectively. The patients were treated using intracranial stent overlapping technique and LEO stents (9 patients using 2 stents, 1 using 3 stents). The aneurysms were occluded by changing the hemodynamics of the aneurysmal cavities, and the parent arteries were preserved. All the patients completed clinical and imaging follow-up study. Results: Circled digit oneOf the 10 patients with VBDAs, 7 had headache, 1 had ataxia, 3 had dizziness, and 1 had facial numbness. Image examination revealed proximal segment stenosis, string and pearl sign, wave shaped, double-lumen sign, and intramural hematoma, respectively. Circled digit twoAngiography revealed contrast agent retention in the aneurysm cavity immediately after stenting. Stent migration occurred in 1 patient, but it did not result neurological dysfunction. Two patients had transient ischemia attack after stenting, it was relieved after symptomatic treatment. The remaining patients did not have any nervous system complications. Head CT scan before discharge did not revealed any new brain infarctions. Circled digit twoAngiographic examination showed that 6 dissecting aneurysms were occluded completely at 6 months after stenting and the other 6 ones were occluded partially. The patients were followed up for 8 to 27 months, and the final mRS score was 0 in 10 patients. There were no technique-related complications in the patients during the follow-up period. Conclusion: Intracranial stent overlaping technique in the treatment of unruptured VBDAs is safe and effective.

An Emergency Stenting for Acute Vertebrobasilar Artery Occlusion: Case Report / 대한뇌혈관외과학회지

Acute vertebrobasilar artery occlusion is a fatal event, even after intra-arterial thrombectomy and thrombolysis. We are reporting a case of acute vertebral artery (VA) occlusion. A 37-year-old man was admitted with mild dizziness, but cardiopulmonary arrest suddenly developed after eleven hours. We performed cardiopulmonary resuscitation immediately and his mental and vital state was recovered. Thus we performed intra-arterial thrombectomy, thrombolysis and balloon angioplasty for left vertebral artery occlusion. But pre-existing stenosis of VA was revealed during intervention so we inserted a stent to the stenotic area. Conclusively, we obtained the good angiographical and clinical outcomes.

Treatment of Vertebrobasilar Artery Dissection / 신경중재치료의학

Intracranial vertebrobasilar artery (VBA) dissection can be classified into three major clinical types: subarachnoid hemorrhage, headache, and nonhemorrhagic ischemic symptoms. And it has been more frequently identified since the introduction of advanced diagnostic imaging modalites including MR angiography and multidetector CT angiography. Aggressive treatment has been considered due to their tendency for early rebleeding and a fatal natural course. We describe approproiate neurointerventional options, based on he patterns of angiographic features and location of dissection.

Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

OBJECTIVE: Hemifacial spasm (HFS) is considered as a reversible pathophysiological condition mainly induced by continuous vascular compression of the facial nerve root exit zone (REZ) at the cerebellopontine angle. As an offending vessel, vertebrobasilar artery tends to compress much more heavily than others. The authors analyzed HFS caused by vertebrobasilar artery and described the relationships between microsurgical findings and clinical courses. METHODS: Out of 1,798 cases treated with microvascular decompression (MVD) from Jan. 1980 to Dec. 2004, the causative vessels were either vertebral artery or basilar artery in 87 patients. Seventy-nine patients were enrolled in this study. Preoperatively, computed tomography (CT) or brain magnetic resonance (MR) imaging with 3-dimentional short range MR technique was performed and CT was checked immediately or 2-3 days after anesthetic recovery. The authors retrospectively analyzed the clinical features, the compression patterns of the vessels at the time of surgery and treatment outcomes. RESULTS: There were 47 were male and 32 female patients. HFS developed on the left side in 52 cases and on the right side in 27. The mean age of onset was 52.3 years (range 19-60) and the mean duration of symptoms was 10.7 years. Many patients (39 cases; 49.1%) had past history of hypertension. HFS caused only by the vertebral artery was 8 cases although most of the other cases were caused by vertebral artery (VA) in combination with its branching arteries. Most frequently, the VA and the posterior inferior cerebellar artery (PICA) were the simultaneous causative blood vessels comprising 32 cases (40.5%), and in 27 cases (34.2%) the VA and the anterior inferior cerebellar artery (AICA) were the offenders. Facial symptoms disappeared in 61 cases (77.2%) immediately after the operation and 68 cases (86.1%) showed good outcome after 6 months. Surgical outcome just after the operation was poor in whom the perforators arose from the offending vessels concurrently (p<0.05). CONCLUSION: In case where the vertebral artery is a cause of HFS, commonly branching arteries associated with main arterial compression on facial REZ requires more definite treatment for proper decompression because of its relatively poor results compared to the condition caused by other vascular compressive origins.

Vertigo due to Stroke

Episodic vertigo frequently occurs in patients suffering from transient ischemia in the distribution of the vertebrobasilar circulation (i.e., vertebrobasilar insufficiency). It may occur in isolation, with other symptoms of vertebrobasilar insufficiency or with persisting symptoms and signs of the infarction of the brain stem and/or cerebellum. Typical attacks of ischemic vertigo are abrupt in onset and last minutes. Ischemic stroke in the distribution of posterior circulation commonly develops acute onset of spontaneous prolonged vertigo and imbalance. As many as 25% of patients with risk factors for stroke who present to an emergency medical setting with isolated, severe vertigo, nystagmus, and postural instability have an infarction of the caudal cerebellum (i.e., pseudo-vestibular neuritis). Since the head thrust test can be performed at the bedside with no requirement of special equipments, it is invaluable for separating 'pseudovestibular neuritis' from true vestibular neuritis. Physicians who evaluate stroke patients should be trained to perform and interpret the result of the head impulse test. Since the inner ear is supplied by the vertebrobasilar circulation, inner ear symptoms are common with ischemia in the distribution. We briefly reviewed the clinical symptoms and neurological examinations of stroke presenting with vertigo, especially focusing on ischemic stroke of the vertebrobasilar territory.

The change of brainstem auditory evoked potential after vertebrobasilar transient is chemic attack / 重庆医科大学学报

Objective:To explore the diagnostic value of brainstem auditory evoked potential(BAEP) in patients with vertebrobasilar transient ischemic attack (TIA). Methods: BAEP was performed in 33 patients with vertebrobasilar TIA. Results: The abnormality rate of BAEP was 75.8%. It showed that theⅠ,Ⅲ or Ⅴ wave was abnormal in some patients. The peak latency (PL) of Ⅰ,Ⅴ waves and the interpeak latency (IPL) of Ⅲ～Ⅴ and Ⅰ～Ⅴ wave from vertebrobasilar TIA was longer than the control group (P

Clinical evaluation of interventional treatment of severe complicated stenosis of vertebrobasilar system / 介入放射学杂志

Objective To evaluate the feasibility,safety and efficacy of percutaneous transluminal stenting angioplasty for severe complicated stenosis of vertebrobasilar system. Methods From November 2003 to February 2006,5 candidates underwent percutaneous transluminal stenting for severe complicated stenosis of vertebrobasilar system. Results Four out of 5 candidates,had occlusion of unilateral vertebral artery (VA),1 had severe bilateral proximal segmental stenosis of VA. There were 4 with severe proximal segmental stenosis of the VA associated with multiple segmental stenosis of intracranial VA and basilar artery (BA),and 1 with multiple segmental severe stenosis of intracranial VA and BA. Stenosis rate ranges from 80% ～95% with involved length from 10-20 mm. Technical success was achieved in all of the patient (100%),and residual stenosis rate was less than 20%. All the symptoms due to vertebrobasilar blood supply insufficiency disappeared. Follow-up with DSA 6-12 months later demonstrated no restenosis; showing satisfactory short term efficacy. Conclusions Percutaneous transluminal stenting for vertebrobasilar blood supply insufficiency is a safe and efficacious option with favorable short term outcome,especially with furthermore prevention of stroke.

Clinical Efficacy of Angioplasty for 26 Patients Suffered from Trunsient Ischemic Affack of Vertebrobasilay System / 医学研究杂志

Objective To evaluate the recent curative effect of the angioplasty of vertebrobasilar system TIA patients.Methods 26 patients of vertebrobasilar system TIA after accepting angioplasty were analyzed retrospectively and were followed-up during 6 months to 9 months with average(7?0.25)months.We analyzed the short-period curative effect of the angioplasty and risk factors.Results 26 patients were accepted angioplasty of 31 vessels,with achievement ratio of technique being 100%,mean preoperative stenosis(82.50?9.95)% reducing to(4.2?3.8)%.1 patient appeared transient ischemic attacked following-up for 6~9months.The symptom disappeared in 24 patients.2 patients relapsed.One was related to take medicine irregularly,the other was related to the hypertension.Conclusion The recent curative effect of angioplasty to vertebrobasilar system TIA patients was satisfactory,but long-ferm efficacy needs to be observed in the further.

Endovascular Intervention of Vertebrobasilar Artery Stenosis / 国际脑血管病杂志

Approximately one-quarter of ischemic stroke occurred in vertebrobasilar artery system. Atherosclerotic vertebrobasilar artery stenosis is one of the major causes of posterior circulation stroke. In addition to the conventional medical and surgical treatment, endovascular intervention has received more and more attention, and it has become the most promising therapeutic approach.

Percutaneous Interventional Treatment of Extracranial Vertebral Artery Stenosis with Coronary Stents

Stenosis of extracranial vertebral artery (VA) is not an infrequent lesion, and it can pose a significant clinical problem. However, the standard treatment for a significant VA stenosis has still not been established. Here in this study, we report our experiences of VA stenting in 25 patients (age 56.2 +/-15.2 years, male 76%). The patients had comorbidities as follows: DM (36%), hypertension (64%), Takayasu's (12%) and Behcet's diseases (4%). There were combined involvement of other vessels such as the coronary artery (72%), carotid artery (36%), subclavian artery (32%) and the contralateral vertebral artery (24%). Indications for stenting were prior stroke or symptoms related to vertebrobasilar ischemia in 11 patients, and an asymptomatic but angiographically significant stenosis (> 70% stenosis) in 14 patients. Twenty-three balloon-expandable stents and two self-expandable stents were deployed. A drug-eluting coronary stent and distal balloon protection device were each used in one case. A technically successful procedure was achieved in all patients. The baseline reference diameter was 4.7 +/-1.3 mm, minimal luminal diameter (MLD) 1.0 +/-0.6 mm (diameter stenosis 77.8 +/-12.5%) and lesion length 6.4 +/-3.9 mm. After stenting and adjuvant dilation, the MLD was increased to 4.5 +/-0.9 mm (diameter stenosis 3.1 +/-17.9%). There were no procedure-related complications. During the further follow-up period of 25 (3-49) months, no stroke or death occurred. Restenosis was observed in 4 (30.8%) of 13 eligible patients. In conclusion, VA stenting is feasible with a high degree of technical success, and this treatment is associated with a relatively low incidence of procedure-related complications. However, a relative high rate of in-stent restenosis remains as a problem to be resolved.

Diagnosis of vertebrobasilar arterial insufficiency by transcranial color duplex sonography / 第三军医大学学报

Objective To evaluate the diagnostic value of transcranial color duplex sonography for vertebrobasilar arterial insufficiency (VBI). Methods Transcranial color duplex sonography was performed on 30 healthy controls and 30 VBI patients confirmed clinically to examine the flow velocities and wave form parameters of the main supra and infra tentorial basal cerebral arteries. The anterior, middle, and posterior cerebral arteries on either side of the cranium and the vertebrobasilar system were observed using a 2.0 MHz transducer of a computed sonographic system. Results The vertebral artery system resistance index and pulsitive index were significantly higher in VBI patients than those in the controls ( P

Vertebrobasilar Pathology of Acute Isolated Vertigo: A Case-Control Study

BACKGROUND : Till now, several studies advocated the vascular etiology as a cause of acute isolated vertigo without relevant lesions on magnetic resonance imaging (MRI). However, most of them were case series and ,even in a few case-control studies, inclusion criteria were obscure and vascular risk factors were not considered. OBJECTIVES: To investigate the clinical significance of vertebrobasilar artery (VBA) pathology in acute isolated vertigo without relevant lesions on MRI. Methods : 84 patients (26 male, 59 female; 62.5+/-0.2 years) with acute isolated vertigo who had no lesions on MRI were gathered. Seventy nine controls (30 male, 49 female; 58.4+/-0.1 years) consisted of subjects with clinically definite BPPV, epilepsy, tension headache, or lacunar infarction. All the subjects underwent MRI and magnetic resonance angiography (MRA). The vascular pathology of VBA and anterior circulation were examined and graded by the findings of MRA. Focal stenosis more than 50%, non- or faint-visualization, or dolichoectasia of VBA were regarded as significant. Risk factors of atherosclerosis were investigated and the severity of small vessel disease on MRI were ranked. RESULTS : Significant vascular pathology of VBA was found more frequently in patients with acute isolated vertigo (32.1%) than in controls (16.5%) (p0.05). Multivariate analysis including all the possible variables investigated confirmed the significant correlation between VBA pathology and acute isolated vertigo in our subjects (p<0.05). CONCLUSION : This study demonstrates that there is a signficant correlation between VBA pathology and acute isolated vertigo without lesions on MRI. It can support the importance of VBA pathology as a a cause of acute isolated vertigo.

A Case of Fenestrated Basilar Artery Associated with Multiple Aneurysms

Fenestrated basilar artery is a uncommon congenital anomaly. It is seen in approximately 0.3 to 5.26% of autopsy series, but only in 0.1 to 1.9% of angiography series. Because the fenestrated basilar artery is a defect or weakness of muscular and internal elastic lamina, incidence of fenestration of the basilar artery when a vertebrobasilar artery aneurysm is present is reported to be 35.5%. We experienced one case of fenestrated basilar artery associated with multiple aneurysms(fenestrated basilar artery, basilar tip, left posterior communicating artery). We operated the basilar tip aneurysm and the posterior communicating artery aneurysm. Although we didn't operate the fenestrated basilar artery aneurysm, we report one case with review of literature in order to improve the operative result of the fenestrated basilar artery aneurysm.

Trigeminal Neuralgia Caused by a Tortuous and Dilated Vertebral Artery

The authors present a 67-year-old man who developed trigeminal neuralia caused by a dolichoectatic vertebrobasilar artery. Brain magnetic resonance imaging showed a tubular structure traversed the anterior surface of the sbrainstem, which compressed the left ven trilateral pons in the region of the trigeminal root entry zone. Vertebral angiography demonstrated a tortuous dilated vertebrobasilar artery. Microvascular decompression of the trigeminal nerve from the dolichoectatic vertebral artery and simultaneous selective trigeminal rhizotomy were performed. Postoperatively, the patient was relieved of pain but suffered a hearing deficit in the ipsilateral side.