Imaging the vertebral artery

Abstract

Although conventional intraarterial digital subtraction angiography remains the gold standard method for imaging the vertebral artery, noninvasive modalities such as ultrasound, multislice computed tomographic angiography and magnetic resonance angiography are constantly improving and are playing an increasingly important role in diagnosing vertebral artery pathology in clinical practice. This paper reviews the current state of vertebral artery imaging from an evidence-based perspective. Normal anatomy, normal variants and a number of pathological entities such as vertebral atherosclerosis, arterial dissection, arteriovenous fistula, subclavian steal syndrome and vertebrobasilar dolichoectasia are discussed.

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

“…23 TOF-MRA allows for visualization of a long segment of an artery with a short acquisition time and may demonstrate luminal narrowing. 2 CTA may demonstrate a narrowed lumen surrounded by mural thickening, which may enhance at its outermost aspect as seen in our patient. 5 Most clinicians, whether medical or practitioners using SMT, when faced with VAD in progress aren't aware that non-specific symptoms such as neck pain and headache may be the only symptoms.…”

“…The intracranial portion (V 4 ) extends from the foramen magnum where it pierces the dura and joins the contralateral VA to form the basilar artery, which perfuses the brainstem, cerebellum, and occipital lobes. 2,14 Extracranial dissection is more common than intracranial, but the V 2 segment (dissected in this case) is the least common of the extracranial segments to dissect because it remains relatively fixed within the transverse foramina along its course. 15 The first and third segments are highly mobile and, thus, are more frequently involved in dissection.…”

“…5 A complication of VAD includes ischemia in the vertebro-basilar artery (VBA) distribution, but stroke in young adults secondary to VAD is far less common than those secondary to dissection of the internal carotid artery. 2,19 A literature review that combined carotid and vertebral artery (cervical artery) dissections indicated that a minority of dissections (6%) were associated with SMT. 20 Lateral medullary infarction (Wallenberg syndrome) is a common ischemic stroke in the VBA distribution.…”

“…15 Findings include luminal stenosis or occlusion, aneurysmal dilation, intimal flap, and double lumen. 2 MRI and MRA are replacing conventional catheter angiography as they are non-invasive, lack ionizing radiation, and offer multiplanar imaging of all major arteries (and veins) of the head and neck. 26 A key MRI finding for VAD is an intramural rim of variable signal intensity (depending on the age of the blood products) surrounding a narrowed lumen.…”

“…1 Arterial dissection occurs when blood penetrates a tear in the intimal layer of the artery and a mural hematoma develops within the tunica media. 2 Dissection of the VA is a rare event, with an estimated incidence of 0.97 to 1.12 per 100 000 individuals per year. 3 Stroke is the most clinically important complication of VAD and causes neurological symptoms that may establish an unequivocal diagnosis.…”