Occipital Artery to Extradural Vertebral Artery Bypass for Posterior Circulation Ischemia

Wang, Xuan; Tong, Xiaoguang; Shi, Minggang; Shang, Yanguo; Wang, Hu

doi:10.1093/ons/opy143

Cited by 17 publications

(11 citation statements)

References 28 publications

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“…For cases not amenable to endovascular treatment, or that have failed endovascular treatment surgical bypass procedures like occipital artery-VA bypass may be considered. 13 However, these procedures are technically challenging and require the patient to withstand surgery and its accompanying risks. In extensive vessel injury like transection, parent vessel has to be sacrificed as reconstructive approach is not feasible.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Iatrogenic Vertebral Artery Transection During Anterior Cervical Spine Surgery: A Case Report

et al. 2021

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Anterior surgical approaches to the cervical spinal pathology have become a frequently used technique. Anterior cervical spine surgeries are generally considered to be safe with low incidence of neurological complications. Vertebral artery (VA) injuries are infrequent during an anterior cervical spine approach but can be devastating. A retrospective review of these injuries documents an incidence of 0.3%-0.5%. However, there is no established strategy or guidelines for managing iatrogenic VA injuries. We describe a case of iatrogenic VA injury at C5 vertebral level during an anterior cervical approach for C5 cervical osteoblastoma; successful managed by endovascular coiling using detachable coils achieving complete occlusion. The patient had a good clinical outcome, with no symptoms of vertebrobasilar insufficiency at 2-year follow-up. There is a paradigm shift in the management of the VA injury after introduction of the interventional angiography. Endovascular embolization is a safe and effective treatment option, which offers certain advantages over open surgery such as minimal invasion, lower risk of neurological injury, lower morbidity, and recurrence rates.

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Section: Discussionmentioning

confidence: 99%

Endovascular Management of Iatrogenic Vertebral Artery Transection During Anterior Cervical Spine Surgery: A Case Report

et al. 2021

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“…55 For patients with posterior circulation vertebral artery disease, a single-center case series reported that surgical revascularization decreased recurrent stroke and death as compared with medical therapy alone, but no RCTs have been performed to establish efficacy and the procedure is considered investigational. 56,57 Indirect Bypass…”

Section: Direct Bypassmentioning

confidence: 99%

Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory

et al. 2022

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Background and ObjectivesTo review treatments for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (sICAS).MethodsThe development of this practice advisory followed the process outlined in the American Academy of Neurology Clinical Practice Guideline Process Manual, 2011 Edition, as amended. The systematic review included studies through November 2020. Recommendations were based on evidence, related evidence, principles of care, and inferences.Major RecommendationsClinicians should recommend aspirin 325 mg/d for long-term prevention of stroke and death and should recommend adding clopidogrel 75 mg/d to aspirin for up to 90 days to further reduce stroke risk in patients with severe (70%–99%) sICAS who have low risk of hemorrhagic transformation. Clinicians should recommend high-intensity statin therapy to achieve a goal low-density lipoprotein cholesterol level <70 mg/dL, a long-term blood pressure target of <140/90 mm Hg, at least moderate physical activity, and treatment of other modifiable vascular risk factors for patients with sICAS. Clinicians should not recommend percutaneous transluminal angioplasty and stenting for stroke prevention in patients with moderate (50%–69%) sICAS or as the initial treatment for stroke prevention in patients with severe sICAS. Clinicians should not routinely recommend angioplasty alone or indirect bypass for stroke prevention in patients with sICAS outside clinical trials. Clinicians should not recommend direct bypass for stroke prevention in patients with sICAS. Clinicians should counsel patients about the risks of percutaneous transluminal angioplasty and stenting and alternative treatments if one of these procedures is being contemplated.

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“…A surgical bypass has been previously shown as a possible treatment option in selected patients with posterior ischemic stroke. 28,29 However, whether bypass surgery, which was performed in patient 5, constitutes a therapeutic option for initial treatment or ought to be resolved as a last-line emergency treatment remains an individual decision. Lastly, a conservative treatment (patient 2) may be successful in cases, in which positional changes induce mechanical stress on brain supplying arteries.…”

Section: Discussionmentioning

confidence: 99%

Bony Stroke: Ischemic Stroke Caused by Mechanical Stress on Brain Supplying Arteries From Anatomical Bone or Cartilage Anomalies

Haertl

Renz

Wunderlich

et al. 2023

Stroke

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Background: Bone or cartilage anomalies with affection of brain supplying arteries are a potential structural cause for ischemic stroke. In the following, we termed this entity bony stroke. Due to rarity of their description, there is no standardized workup and therapy for bony strokes. Methods: Retrospectively, we extracted diagnostic and therapeutic workup of all patients considered to have had a bony stroke between January 2017 to March 2022 at our comprehensive care center. Results: In total, 6 patients classified as a bony stroke were identified among 4200 acute patients with ischemic stroke treated during the study period. Each patient had recurrent ischemic strokes in the dependent vascular territory before diagnosis. Diagnosis was achieved by a combination of imaging devices, including sonography, computed tomography, and magnetic resonance imaging. In addition to conventional static imaging, the application of dynamic imaging modalities with the patients’ head in rotation or reclination confirmed a vessel affection following head movements in 3 patients (50%). Treatment options were interdisciplinary assessed and included the following: conservative treatment (n=1), endovascular stenting (n=2) or occlusion (n=2), surgical removal of bone/ cartilage (n=2), and surgical bypass treatment (n=1). In follow-up (mean 11.7 months), no patient experienced further ischemia. Conclusions: As a differential diagnosis, bony strokes may be considered in patients with recurrent ischemic stroke of unknown cause in one dependent vascular territory. Interdisciplinary evaluation and treatment may eliminate risk of stroke recurrence.

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Occipital Artery to Extradural Vertebral Artery Bypass for Posterior Circulation Ischemia

Cited by 17 publications

References 28 publications

Endovascular Management of Iatrogenic Vertebral Artery Transection During Anterior Cervical Spine Surgery: A Case Report

Endovascular Management of Iatrogenic Vertebral Artery Transection During Anterior Cervical Spine Surgery: A Case Report

Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory

Bony Stroke: Ischemic Stroke Caused by Mechanical Stress on Brain Supplying Arteries From Anatomical Bone or Cartilage Anomalies

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