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Arteriography of the vascular beds
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
The aortic arch is demonstrated en face when an LAO projection is used (see Chapter 9, Figure 9.1). This helps to separate the origins of the arch branches. If an area of expected critical stenosis appears only mildly diseased, additional interrogation, such as oblique views, should be considered. The degree of stenosis at the carotid bifurcation and proximal internal carotid artery is best evaluated with lateral or steep oblique views. During arch aortography, the patient should turn the head 20–30 degrees to the right. This maneuver helps to separate the carotid and vertebral arteries. The innominate artery bifurcation into proximal right common carotid and right subclavian is best viewed in an RAO projection. The vertebral artery usually has its origin from the posterior wall of the subclavian artery. Therefore, to view the proximal vertebral artery, which often harbors orificial stenosis, the image intensifier is placed into a slight craniocaudal position, and may require some angulation as well.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The vertebral artery gives off the posterior inferior cerebellar artery, which is its largest branch and supplies the cerebellum. The anterior and posterior spinal arteries also arise from the vertebral artery and supply the medulla in addition to the spinal cord.
Stenting for occlusive disease of the aortic arch branches
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Timothy M. Sullivan, Jessica M. Titus
The vertebral artery origin is often located close to the subclavian disease. In situations where treatment of the lesion could result in inadvertent coverage of the vertebral origin, protection of the vessel should be considered. The risk of emboli to the vertebral distribution is low so, although placement of protection devices has been described, they are not widely used. In situations of subclavian steal syndrome, where reversal of flow has been confirmed by US, the patient is already protected from an embolic standpoint and protection devices would expose the artery to unnecessary risk of vessel injury. Vertebral artery origin protection during subclavian intervention can be achieved in a variety of ways. If brachial access has been obtained, a wire and catheter can be positioned in the vertebral origin to ensure against coverage during intervention. If only femoral access is used, a buddy wire may be used. This requires slight oversizing of the sheath to allow for the passage of two wires. One wire is extended into the axillary artery while the other is advanced into the vertebral artery. Both wires can be exchanged for 0.014-inch wires; a balloon-expandable stent can be advanced over these wires for deployment. If the stent cannot be advanced over both wires, it should be passed over the axillary wire to avoid injury to the vertebral origin during intervention.
Center of pressure velocities in patients with body lateropulsion: three case report series of Wallenberg’s syndrome
Published in Physiotherapy Theory and Practice, 2022
Hideaki Matsuo, Masafumi Kubota, Mayumi Matsumura, Mami Takayama, Yuri Mae, Yuki Kitazaki, Soichi Enomoto, Asako Ueno, Masamichi Ikawa, Tadanori Hamano, Ai Takahashi, Misao Tsubokawa, Seiichiro Shimada
Patient 1 was a 44-year-old man who presented to the emergency department with cold sweats and numbness on the left side. The patient had no underlying disease or smoking habit but reported heavy alcohol consumption every night. Upon arrival, the patient was alert and had apparent right Horner’s syndrome, pain and temperature sensory loss on the left side, hoarseness, torsional nystagmus, velopharyngeal incompetence on the right side, and a National Institutes of Health Stroke Scale (NIHSS) score of 4. Magnetic resonance imaging (MRI) revealed hyperintensity in diffusion-weighted images (DWIs) of the right lateral side of the medulla (Figure 1a). Magnetic resonance angiography revealed a right vertebral artery dissection. The patient’s clinical diagnosis was Wallenberg’s syndrome because of the dissection of the vertebral artery.
Vertebral artery dissection and high-intensity workouts
Published in Baylor University Medical Center Proceedings, 2021
Kenneth J. Guinn, Raycho G. Kurkchijski, Christie A. Shen
The following morning, a neurology exam showed only nonspecific dysarthria. An electrocardiogram showed sinus bradycardia, with no findings on echocardiogram and a low-density lipoprotein cholesterol of 90 mg/dL. Magnetic resonance (MR) imaging of the head showed a small acute infarct in the right posterior lateral medulla (Figure 1). Further consultation with a neuroradiologist confirmed dissection of the right vertebral artery. At this time, the patient’s symptoms had improved, with only a mild dysarthria remaining. He was continued on aspirin and statin therapy, which was later discontinued as an outpatient. A detailed social history noted the patient started CrossFit-style workouts 6 months earlier and discontinued bupropion 1 week earlier due to improved mental health. The patient was encouraged to refrain from exercise involving the upper extremities for at least 3 months.
Comparison of radiological versus clinical cerebral vasospasm after aneurysmal subarachnoid hemorrhage: is vasospasm always present?
Published in Neurological Research, 2020
Djula Djilvesi, Igor Horvat, Bojan Jelaca, Jagos Golubovic, Filip Pajicic, Petar Vulekovic
Control CTA findings were analyzed independently by a radiologist and researcher. Data about the presence, region and intensity of vasospasm were determined by radiologist comparing control and admission CTA findings, without exact measuring the blood vessels. Researcher measured seven segments of the proximal blood vessels of the brain in their distal parts at admission and control CTA: 1. suprasellar part of the Internal carotid artery; 2. M1 segment of the Medial cerebral artery; 3. A1 segment of the Anterior cerebral artery; 4. A2 segment of the Anterior cerebral artery; 5. P1 segment of the Posterior cerebral artery; 6. vertebral artery, and 7. basilar artery. If there were signs of vasospasm in distal circulation (M2 and M3), these data were noted and taken into account in statistical analysis. In determining the presence of vasospasm, findings by both a radiologist and researcher were taken into account. The presence of cerebral vasospasm was classified as: 1. present (degree of narrowing of the blood vessel 5–100%, taking into account the possibility of error in the measurement) and 2. absent (0–5% narrowing). Narrowing of the arteries on angiographic images on the basis of the measured values was classified into: 1. mild (5–33%); 2. moderate (34–66%), and 3. severe (67–100%).