Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography

Uchino, Akira; Saito, Naoko; Takahashi, Masahiro; Okada, Yoshitaka; Kozawa, Eito; Nishi, Naoko; Mizukoshi, Waka; Nakajima, Reiko; Watanabe, Yusuke

doi:10.1007/s00234-013-1142-0

Cited by 69 publications

(76 citation statements)

References 26 publications

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“…Direct aortic origin of the left VA between the left common carotid artery and left subclavian artery was found 4.1% which is the most seen variation and called as type 3 aortic arch in most of the studies. At the same study right VA originating from aberrant right subclavian artery prevalence was 0.4% [16]. In our study there were 13 patients with variations in the origin of the VA (5.1%).…”

Section: Discussionsupporting

confidence: 66%

“…In the literature vertebral arteries are investigated by colour Doppler ultrasound, anatomic studies, computed tomography angiography (CTA) and conventional angiography in many years [10,11,[14][15][16]. B-mode and colour Doppler ultrasound is the first--step method in evaluation of vertebrobasilar system.…”

Section: Discussionmentioning

confidence: 99%

“…Uchino et al [16] identified the variations in VA origin with CTA among 2287 patients. Direct aortic origin of the left VA between the left common carotid artery and left subclavian artery was found 4.1% which is the most seen variation and called as type 3 aortic arch in most of the studies.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients

Ergün

Tatar²,

Birgi³

et al. 2016

Folia Morphol

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients

Ergün

Tatar²,

Birgi³

et al. 2016

Folia Morphol

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“…We agree that we missed their paper [1], which was published just before the submission of our paper [2]. Our article was written after a careful literature search at a time when their paper was not yet online.…”

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confidence: 94%

Response to letter to the editor (NRAD-13-78) Re: Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography Dan Meila; Marcin Tysiac; Friedhelm Brassel

Uchino

2013

Neuroradiology

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Dear Sir, We thank Dr. Meila and colleagues for their valuable comments. We agree that we missed their paper [1], which was published just before the submission of our paper [2]. Our article was written after a careful literature search at a time when their paper was not yet online. Unfortunately, we did not repeat the literature search when revising our paper. It is noteworthy that the two reviewers were not aware of their article. We sincerely apologize to Dr. Meila and colleagues for our incomplete review of the literature and are happy we can bring their article to the attention of the readers of Neuroradiology in this way.In regard to the scientific issue Dr. Meila raises, we understand they presented a case of duplicate origin of the left vertebral artery with both branches arising from the aortic arch directly. Our double aortic arch model cannot explain this extremely rare variation. Thus, we agree with their opinion that variations of the vertebral artery system can occur at nearly any level.Again, we repeat our apologies and hope that Dr Meila and his co-authors may accept them.

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Re: Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography

2013

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Dear Sir, We read with interest and pleasure the recently published article: "Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography" by Uchino et al. [1]. Unfortunately, the authors forgot to mention or ignored our previously published work: "Origin and course of the extracranial vertebral artery: CTA findings and embryologic considerations" [2]. This paper deals exactly with the variations of the origin and course of the extracranial vertebral artery as described by Uchino and colleagues and demonstrates clearly the relationship to the level of entrance into the transverse foramen. We were able to demonstrate that the level of entrance into the transverse foramen indicates which metameric artery or arteries in case of duplication persist. Additionally, we illustrated the variations in modified schematic figures and a matrix for the vertebro-basilar system adapted from Lasjaunias et al. [3]. Uchino et al. found that 0.2 % of left vertebral arteries arose from the aortic arch distal to the left subclavian artery and entered the seventh transverse foramen. They state that their study is the first to report its prevalence. However, we previously showed in our large CTA study the frequency of this variation to be 0.56 %, which is quite similar. Furthermore, the authors deal with the duplicated origin of the vertebral arteries. They stated that all patients in literature (including other works but not ours) demonstrate left vertebral arteries of normal origin and of aortic arch origin that fuse together. They believe that the duplicate origin of the left vertebral artery forms if both the seventh and sixth segmental arteries persist. This is a generalization that does not fit always. We showed one case with bilateral duplication of the vertebral arteries. On the left side, both vertebral arteries originated from the aortic arch with the distal segment entering the transverse foramen at the level of C5, corresponding to the sixth metameric or segmental artery and the proximal segment entering at the level of C4, corresponding to the fifth segmental artery, respectively. In our opinion, variations of the vertebral artery system can occur nearly at any level. The basic principles of metameric distribution should be mastered to understand and recognize these variations.Conflict of interest We declare that we have no conflict of interest.

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Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography

Cited by 69 publications

References 26 publications

Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients

Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients

Response to letter to the editor (NRAD-13-78) Re: Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography Dan Meila; Marcin Tysiac; Friedhelm Brassel

Re: Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography

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