Aberrant Origin of Vertebral Artery and Its Clinical Implications

Abstract

Aberrant origin of vertebral artery is rare. The anatomical features and clinical significance of this lesion remain to be clarified. A comprehensive collection of the pertinent literature resulted in a cohort of 1286 cases involving 955 patients and 331 cadavers. There were more left than right and more unilateral than bilateral aberrant vertebral arteries. Patients with aberrant origin of vertebral artery were often asymptomatic and in only 5.5% of the patients their symptoms were probably related to the aberrant origin of vertebral artery. The acquired cardiovascular lesions were present in 9.5% of the patients, 20.9% of which were vertebral artery-associated lesions. Eight (0.8%) patients had a vertebral artery dissection. Logistic regression analysis showed significant regressions between bovine trunk and left vertebral artery (P=0.000), between the dual origins of vertebral artery and cerebral infarct/thrombus (P=0.041), between associated alternative congenital vascular variants and cervical/aortic dissection/atherosclerosis (P=0.008). Multiple logistic regression demonstrated that side of the aberrant origin of vertebral artery (left vertebral artery) (P=0.014), arch branch pattern (direct arch origin) (P=0.019), presence of the common trunk (P=0.019), associated acquired vascular disorder (P=0.034) and the patients who warranted management (P=0.000) were significant risk predictors for neurological sequelea. The patients with neurological symptoms and those for neck and chest operations/ interventions should be carefully screened for the possibility of an aberrant origin of vertebral artery. The results from the cadaver metrology study are very helpful in the design of the aortic stent. The arch branch pattern has to be taken into consideration before any maneuver in the local region so as to avoid unexpected events in relation to aberrant vertebral artery.

Republished: Multiple anomalies in the origin and course of vertebral arteries and aberrant right subclavian artery in a child with moyamoya syndrome

“…The most common variant is direct aortic arch origin of the left VA 1. Bilateral anomalous origin of the VA is uncommonly seen with a prevalence of 2.8% 1.…”

“…Possible variations in the origin of vertebral artery (VA) are well documented and analyzed in the literature 1. However, common carotid artery (CCA) origin of the VA, combined with symmetrical bilateral segmental absence of VA and aberrant right subclavian artery (ARSCA) in the context of Moyamoya syndrome (MMS) without accompanying segmental agenesis of the internal carotid arteries (ICAs) has not been reported yet.…”

A study of variations of subclavian artery and its clinical implication

“…Patient with VA duplication may have symptoms such as vertigo, dizziness, and occipital heaviness due to posterior circular insufficiency. [9] The embryological mechanism of ARSCA with an RVA from the RCCA (VA-CCA) has been explained in several studies. During embryonic period, the first to 6 th cervical intersegmental arteries (CIA's) develops into the VA and seventh CIA makes the ARSCA.…”

“…Any alteration in VA in its origin, course, diameter, duplication, fenestration, tortuosity, elongation, kinking, aneurysmal formation, and associated heredity connective tissue disorder may alter the hemodynamics of brain which can leads to serious complication. [9] In this case, alteration in diameter and beaded appearance of the right VA (RVA) was seen which indicate that there may be possibility of alteration of hemodynamic of brain persists.…”

“…It ascents through foramina transversaria of all six cervical vertebrae and enters into cranial cavity through foramen magnum to supply different part of the brain after the formation of a circle of Willis. [8,9] Variations in origin and course of VA found in 7% cases, more on the left side (5%) than the right side (1-3%), and more unilateral (12.4%) than bilateral (0.8%). The patient usually remains asymptomatic unless the VA is involved by atherosclerotic lesion.…”