Occlusion of the vertebral artery

Abstract

The angiographic demonstration of an occluded vertebral artery in a patient with a brain-stem syndrome was first reported by Riechert in 1952, and similar cases have been described by various authors subsequently. The common site of the vertebral occlusion was in the area between the arch of the atlas and the junction of the vertebral arteries. Since routine brachial angiography has been initiated in this clinic, occlusion of the vertebral artery at this site has been noticed more frequently than expected. Despite good visualization of the vertebral artery, the injected contrast material sometimes stopped before the junction of the vertebral arteries, and the basilar artery was not demonstrated in a number of patients who did not have clinical evidence of vertebral or basilar artery occlusion. This observation has been mentioned by Sutton and Hoare (1951), and by Krayenbuhl and Ya,argil (1957a) and was considered by them to be due to technical failure or vascular spasm. This explanation did not seem satisfactory for many instances in which we encountered an apparent vertebral artery occlusion. Therefore a series of 150 consecutive brachial angiograms has been reviewed in order to determine the frequency with which occlusion of the vertebral artery with or without symptoms occurs, and if possible to elucidate further its clinical and physiological significance. METHODThe initial 100 brachial angiograms were carried out by a percutaneous catheterization technique (Shenkin, Tatsumi, and Bantley, 1962) and the subsequent 50 using a direct percutaneous method as suggested by Siqueira, Karras, Cannon, and Bucy (1962). The latter method was not only less time consuming but seldom if ever interfered with the quality of the brachial pulse after the study was completed. A thin-wall 18 gauge needle was introduced into the brachial artery percutaneously at the antecubital fossa and connected to an automatic injector. Fifty-five millilitres of 60% methylglucamine diatrizoate (Renografin) were injected into the brachial artery with a pressure of 425 lb. The first film was exposed when 30 ml. of the dye had been injected and a series of six films was taken at one-second intervals in the antero-posterior and lateral projections simultaneously. The right brachial injection One hundred and fifty consecutive patients were studied with the above methods and the series is composed of 27 patients suspected of harbouring a brain tumour, 30 patients with a space-occupying lesion, 32 cases of subarachnoid haemorrhage, and 61 patients with cerebrovascular disease. Of these 150 cases, 15 patients were subjected to bilateral brachial angiography for the following reasons:1 Six patients suffering from subarachnoid haemorrhage failed to demonstrate the basilar artery by right brachial angiography.2 Seven patients representing a suspected vascular lesion within the brain-stem failed to demonstrate the basilar artery by a unilateral brachial injection.3 Studies in two patients had already demonstrated multiple occlusive disease of major cerebr...

A young woman with traumatic vertebral artery occlusion: a case report

“…Vertebral artery occlusion (VAO) was first described by Riechert in 1952 in angiography of a patient with a brain-stem syndrome; later, similar cases were reported. 1 VAO is a potentially life-threatening scenario and may cause serious and even fatal neurological deficits due to brain-stem and cerebellar infarctions. This may result in stroke or may give rise to isolated or combined symptoms and signs of altered consciousness, speech defects, diplopia, blurred vision, nystagmus and dysphagia.…”

Bilateral Obstruction of the Vertebral Arteries

“…Other than the important clinico-pathological case histories described by F isher el al. [1961] and by Y ates and H utchinson [1961], and the surgical cases of de Backey et al [1962], we have found only isolate case reports, [2,11,12,21,22,25,28],In the present paper we describe two patients who were observed re cently, in Psychiatric Hospital of Reggio Emilia, and in Psychiatric Institut 'Paolo Pini' of Milan. …”

“…These general principles are illustrated by many instances where com plete occlusion of both vertebral arteries [1,14,26,28] has not led to any obvious clinical consequence; in such subjects the circle of Willis has been fully patent and has immediately permitted the carotid circulation to draw blood from the vertebral circulation, or vice-versa. In one patient of ours, reported in an earlier paper [19b], it was demonstrated beyond doubt that not a single abnormality, clinical sign or symptom, could be detected in a subject whose brain was being supplied solely by the left vertebral artery, but where the circle of Willis was evidently perfectly effective.…”

“…No anatomical abnormality of the circle of Willis was present. view it appears more than probable that the clinical rarity of such cases is actually more apparent than real [2,24,25,28,30] and results from the limitations which are, in practice, placed upon the systematic use of verte bral arteriography. From the physio-pathological point of view, the cases again confirm some principles which, in recent years, have justly attracted attention [7,11,12,13,14,16,26,31]; in particular angiographic [3,12,14,25] and anatomical [6,8,13,15,21,30] reports have laid emphasis on the possible mechanisms of hemodynamic compensation of the cere bral circulation.…”

Arteria vertebralis thrombosis egy 7 éves gyermekben

“…A polycytaemia vera myeloproliferativ betegség, mely a fokozott vérviszkozitás miatt szintén hozzájárulhat thromboemboliás folyamatok kialakulásához [9]. Az a. vertebralis elzáródásának leggyakoribb helye az atlas ívének és az a. vertebralisnak a találkozása közötti terület [10].…”