Shuichi Tanoue1, Hidenori Endo2, Masafumi Hiramatsu3, Yuji Matsumaru4, Yasushi Matsumoto5, Kenichi Sato5, Wataro Tsuruta6, Masayuki Sato4, Masaru Hirohata7, Toshi Abe8, Hiro Kiyosue9. 1. Department of Radiology, Kurume University School of Medicine, Kurume, Japan. tanoue_shuchi@med.kurume-u.ac.jp. 2. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 3. Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 4. Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 5. Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan. 6. Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan. 7. Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan. 8. Department of Radiology, Kurume University School of Medicine, Kurume, Japan. 9. Department of Radiology, Oita University Faculty of Medicine, Oita, Japan.
Abstract
BACKGROUND AND PURPOSE: Endovascular trapping of the vertebral artery dissecting aneurysms (VADAs) carries a risk of medullary infarction due to the occlusion of the perforating arteries. We evaluated the detectability and anatomical variations of perforating arteries arising from the vertebral artery (VA) using three-dimensional DSA. METHODS: In 120 patients without VA lesions who underwent rotational vertebral arteriography, the anatomical configurations of perforating arteries from the VA were retrospectively evaluated on the bi-plane DSA and reconstructed images to reach the consensus between two experienced reviewers. The images were interpreted by focusing on the numbers and types of perforating arteries, the relationships between the number of perforators and the anatomy of the VA and its branches. RESULTS: Zero, 1, 2, 3, 4, and 6 perforators were detected in 2, 51, 56, 9, 1, and 1 patient, respectively (median of 2 perforators per VA). The 200 perforators were classified into 146 terminal and 54 longitudinal course types and into 32 ventral, 151 lateral, and 17 dorsolateral distribution types. All ventral type perforators were also terminal type. In contrast, the longitudinal type was seen in 28.5% of lateral types and in 65% of dorsolateral types. Regarding the difference in the origin of the posterior inferior cerebellar artery (PICA), non-PICA type VAs gave off larger number of perforators than the other types of VAs. CONCLUSIONS: Non-PICA type VAs give off a significantly larger number of perforators than other types, indicating that the trapping of non-PICA type VAs is associated with a risk of ischemic complications.
BACKGROUND AND PURPOSE: Endovascular trapping of the vertebral artery dissecting aneurysms (VADAs) carries a risk of medullary infarction due to the occlusion of the perforating arteries. We evaluated the detectability and anatomical variations of perforating arteries arising from the vertebral artery (VA) using three-dimensional DSA. METHODS: In 120 patients without VA lesions who underwent rotational vertebral arteriography, the anatomical configurations of perforating arteries from the VA were retrospectively evaluated on the bi-plane DSA and reconstructed images to reach the consensus between two experienced reviewers. The images were interpreted by focusing on the numbers and types of perforating arteries, the relationships between the number of perforators and the anatomy of the VA and its branches. RESULTS: Zero, 1, 2, 3, 4, and 6 perforators were detected in 2, 51, 56, 9, 1, and 1 patient, respectively (median of 2 perforators per VA). The 200 perforators were classified into 146 terminal and 54 longitudinal course types and into 32 ventral, 151 lateral, and 17 dorsolateral distribution types. All ventral type perforators were also terminal type. In contrast, the longitudinal type was seen in 28.5% of lateral types and in 65% of dorsolateral types. Regarding the difference in the origin of the posterior inferior cerebellar artery (PICA), non-PICA type VAs gave off larger number of perforators than the other types of VAs. CONCLUSIONS: Non-PICA type VAs give off a significantly larger number of perforators than other types, indicating that the trapping of non-PICA type VAs is associated with a risk of ischemic complications.
Entities:
Keywords:
3D DSA; Anatomical variation; Perforating artery; Vertebral artery