Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

Abstract

The cervical anterior spinal artery (ASA) is a very important artery arising from the intracranial vertebral artery (VA). It can play different roles in endovascular treatment (EVT) of spinal vascular diseases. The current understanding of these roles is incomplete; therefore, we performed this review. We found that cervical ASA can be involved in many spinal vascular diseases, such as arteriovenous fistula (AVF), arteriovenous malformation (AVM), and aneurysm, and can serve as a collateral channel in proximal VA occlusion. In AVF and AVM, when the cervical ASA is involved, it often plays the role of an accomplice or victim because it acts as the feeder or as a bystander that does not provide blood flow to the AVF and AVM. In cervical ASA aneurysm, the ASA is a victim. During EVT of VA aneurysms or stenoses, the cervical ASA ostia can be covered or occluded, resulting in ASA ischemia. In this situation, the ASA is a victim. In VA occlusion or the subclavian steal phenomenon, the cervical ASA can serve as a collateral channel to provide blood flow to the posterior circulation. In this case, the ASA plays the role of a friend. According to the role of the cervical ASA in spinal vascular diseases, EVT should be determined “case by case.” Most importantly, when EVT is performed to treat these diseases, the cervical ASA axis must be preserved. Therefore, understanding the role of the cervical ASA in spinal vascular diseases is crucial.

Clip Ligation and Disconnection of a Ruptured Ventral Subaxial Cervical Isolated Spinal Aneurysm Using Tailored Access Osteotomies: An Operative Technique

“…[30][31][32][33][34][35][36][37][38][39][40][41][42][43] iSA of the subaxial cervical spine is a highly morbid pathology addressed by individualized strategies. 6,9 Treatment is dictated by angioarchitecture and accessibility, intimately tied to segmental arterial anatomy [6][7][8][9][10] (Figure 4). Within the cervical spine, 2 to 4 radicular arteries variably branch into the RMA, dorsal and vRPA, or any combination thereof, the former coursing toward the midline before dividing into ascending and descending branches supplying the ASA 7,30 (Figure 4).…”

“…6,9 Treatment is dictated by angioarchitecture and accessibility, intimately tied to segmental arterial anatomy [6][7][8][9][10] (Figure 4). Within the cervical spine, 2 to 4 radicular arteries variably branch into the RMA, dorsal and vRPA, or any combination thereof, the former coursing toward the midline before dividing into ascending and descending branches supplying the ASA 7,30 (Figure 4). The RMA and ASA perfuse the intramedullary sulcocommissural system and collateralize richly on the pial surface through the VPP with contributions from vRPAs and anastomotic pial coronal vessels from which intramedullary perforators originate.…”

“…solated spinal aneurysms (iSAs) are generally fusiform lesions of the spinal vasculature with no associated vascular malformation which typically present ruptured as spontaneous subarachnoid hemorrhage (sSAH) along small vessel segments, affecting the anterior spinal artery (ASA), segmental radiculomedullary (RMA), or ventral radiculopial (vRPA) arteries in over 75% of cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Rupture carries a high rate of morbidity, typically through acute spinal cord injury. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Treatment strategies feature conservative, endovascular, open, and multimodal options.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Treatment strategies feature conservative, endovascular, open, and multimodal options. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] iSAs of the ventral spinal axis, particularly around the cervical enlargement, are often managed by conservative measures secondary to small vessel caliber, eloquent angioarchitecture, and inaccessible anatomy. 3,4,6,9,11,13,[16][17][18][19][20][21][22][23] Surgical and endovascular options are limited by safe access, typically for iSAs located distal to the cervical enlargement, where large caliber vessels and increased working room make conditions more favorable.…”

Prospects and Dilemmas of Endovascular Treatment for Vertebrobasilar Dolichoectasia

“…During stenting reconstruction, the non-dominant VA should be occluded immediately after stent deployment to reduce the blood flow into the space between the stents and the vascular wall, which can further improve the hemodynamics of the VBD ( 55 ). The occlusion should be made distal to the posterior inferior cerebellar artery, and any branches originating from the VA in these cases must be preserved, especially those of the anterior spinal artery ( 56 ).…”