Safety of Unilateral Endovascular Occlusion of the Cervical Segment of the Vertebral Artery without Antecedent Balloon Test Occlusion

Zoarski, Gregg H.; Seth, Rajiv

doi:10.3174/ajnr.a3885

Cited by 29 publications

(37 citation statements)

References 18 publications

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“…На наш взгляд, определенный интерес могут представлять данные 16 публикаций, обобщающих достаточно большие клинические серии, которые мы не включили в анализи-руемую выборку из-за их несоответствия оцениваемым нами параметрам, но посвященных непосредственным манипуляциям на позвоночной артерии у пациентов с опухолевыми процессами. Часть этих работ посвящена успешной превентивной эндоваскулярной эмболизации [4,73,74], в других упоминаются отсроченные (до 11 сут) ишемические нарушения [75,76]. Несмотря на это, все авторы рекомендуют эмболизацию позвоночной артерии как эффективную и безопасную процедуру.…”

Section: Discussionunclassified

“…Mattei et al [87] рекомендуют выполнять заднюю инструментальную фиксацию шейного отдела позвоночника отдельным этапом, до любых манипуляций с позвоночной артерией, обосновывая это возможным ее повреждением при проведении Несмотря на низкий процент осложнений при одностороннем прекращении кровотока по позвоночной артерии, сам их характер является инвалидизирующим. И хотя ряд авторов [4,75], ссылаясь на малые выборки и возникновение отдаленных осложнений, ставит под сомнение эффективность временного окклюзионного теста для прогнозирования ишемических последствий, его выполнение эндоваскулярным или открытым способом с использованием нейрофизиологического мониторинга может быть оправдано во избежание части острых неврологических осложнений [2,3,6,28,83,84].…”

Section: Discussionunclassified

“…Классический анатомический вариант кровотока с полноценными позвоночными, сонными и соединительными артериями встречается только у 34,5 % населения; остальные представлены 83 вариантами -от полностью изолированных бассейнов сонных и позвоночных артерий до сложных систем сосудистых коллатералей [1]. В связи с этим клинические проявления нарушений кровотока по позвоночным артериям не вполне предсказуемы и могут варьировать от бессимптомного течения до тяжелой ишемии головного мозга [2][3][4].…”

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Surgery of cervical spine tumors in the close vicinity to the vertebral artery: literature review

Glukhov

Зорин²,

Mushkin

2020

Hir. pozvonoč.

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Objective. To analyze the literature on cervical spine tumors located in the region of the vertebral artery. Material and Methods. Sixty five publications containing data on the surgical treatment of 101 patients with tumors of the cervical spine located in the area of V1-V3 vertebral artery segments were selected for the literature review. Results. The analysis of publications was performed according to the following criteria: demographic data, complaints, histological type of tumor, involvement of the vertebral artery, the performed occlusion test, final embolization or ligation of the artery during surgery, and postoperative complications. The group of patients described in selected publications consisted of 66 men and 35 women, whose average age at the time of surgery was 38.7 years. Acute development of neurological symptoms at the prehospital stage caused by vertebral artery compression was observed in two cases. The C2-C4 vertebrae were most often affected, and the malignant process was confirmed in 70.3 % of cases. In 27 cases, patients underwent an occlusion test of the involved vertebral artery. At the preoperative stage, the final embolization of the artery was performed in 9 cases, the artery was tied during the main operation and removed together with the tumor-in 25, and damaged-in 7. Neurological disorders associated with stopping blood flow through the vertebral artery were noted in two cases. In a number of cases, patients underwent vascular anastomosis with preservation of blood flow at follow-up examination. Conclusion. Taking into account the obtained data and careful preoperative planning will improve the treatment of this group of patients, increase survival, and reduce the risks of possible neurological disorders and tumor recurrence.

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Section: Discussionunclassified

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Surgery of cervical spine tumors in the close vicinity to the vertebral artery: literature review

Glukhov

Зорин²,

Mushkin

2020

Hir. pozvonoč.

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“…14,26 However, there is very little evidence to show a clinical benefit or reliability for BTO in unilateral VA occlusion. 26,27,31 Unilateral therapeutic VA occlusion has been proposed to be safe without an antecedent BTO if a contralateral VA is present, patent, and contributes to the vertebrobasilar junction; there is anatomical potential for retrograde filling of the ipsilateral PICA; and there are no brainstem vessels originating from the target segment of the affected VA. 31 BTO was not used in any of the presented cases since the contralateral VA was adequate, good potential for retrograde filling was rendered angiographically, and the ipsilateral PICA was additionally protected by the bypass. In case 1, however, the contralateral PICA was unfavorable, and thus an interposition graft was used for the ipsilateral V 3 -PICA bypass.…”

Section: Discussionmentioning

confidence: 99%

Fusiform vertebral artery aneurysms involving the posterior inferior cerebellar artery origin associated with the sole angiographic anterior spinal artery origin: technical case report and treatment paradigm proposal

Rāviņa¹,

Strickland

Rennert

et al. 2019

Journal of Neurosurgery

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Fusiform aneurysms of the vertebral artery (VA) involving the posterior inferior cerebellar artery (PICA) origin are uncommon and challenging. The anterior spinal artery (ASA) commonly originates from a unilateral ramus just distal to the PICA. Occlusion of an unpaired ASA can result in bilateral medial medullary syndrome. The authors propose a treatment paradigm for ASA preservation based on the artery’s proximity to fusiform VA aneurysms, and they present 3 representative cases. In the first case, they performed a V3-PICA bypass using an interposition graft and then performed endovascular coil embolization of the parent VA. A complete occlusion of the aneurysm and VA was complicated by ASA thrombosis. The subsequent cases were treated with PICA-PICA bypass and subsequent endovascular embolization of the VA. Filling of the sole angiographic ASA remote from the aneurysm was preserved in both cases. The anatomy of the ASA is the most critical determinant of treatment recommendations for fusiform VA aneurysms involving PICA. When the ASA originates from the aneurysm, proximal occlusion with or without a PICA bypass is suggested. In cases in which the ASA is removed from the aneurysm, the authors recommend revascularization followed by endovascular sacrifice. When the aneurysm is immediately adjacent to the ASA, revascularization and open trapping should be considered.

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“…Although most intracranial VADAs can be treated with a deconstructive approach, a cerebrovascular ischemic event and re-bleeding still happen in some patients (7). Furthermore, the application of the deconstructive approach by parent artery sacrifice is limited when the hypoplastic contralateral vertebral artery cannot provide adequate posterior circulation blood supply following an ipsilateral vertebral artery occlusion (8). With the increasing development of the capabilities of stents and embolization materials, an endovascular reconstructive method with or without stents is preferred for the treatment of acute intracranial VADAs (9).…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy and Quality of Life Follow-Up of Reconstructive Endovascular Therapy for Acute Intracranial Vertebral Artery Dissection Aneurysms

Gao

Luo

et al. 2020

Front. Surg.

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Background: Intracranial vertebral artery dissection aneurysms (VADAs) may cause acute ischemia or hemorrhage, in which case urgent endovascular treatment will be needed. Although the majority of patients obtain a good functional outcome after surgery, a surprising finding has been a poor quality of life (QOL) in follow-up. The purpose of this study was to evaluate clinical efficacy in reconstructive endovascular therapy for acute intracranial VADAs and to analyze the factors contributing to subsequent QOL. Methods: In this prospective study, 33 consecutive VADA patients with subarachnoid hemorrhage were recruited for comparison with 37 VADA patients with posterior circulation cerebral ischemia. All VADA patients were treated using a reconstructive strategy. Clinical, radiological, neurological, and cognitive data, as well as QOL, were assessed at admission and 6 months after surgery. Stoke Specific Quality of Life (SS-QOL) was evaluated for patients with good functional outcome [modified Ranking Scale (mRS) scoring 0-2] for subgroup analysis. Predictors for QOL at follow-up were analyzed by regression model. Results: Immediate angiography after surgery showed complete VADA obliteration in 57 (81.4%) patients and partial obliteration in 13 (18.6%) patients. Three (4.3%) cases suffered from perioperative complications, comprising two cases of stent thrombosis in the hemorrhagic group and one case of posterior inferior cerebellar artery occlusion in the ischemic group. Twenty-five (75.8%) patients in the hemorrhagic group and 30 (81.1%) patients in the ischemic group had a favorable outcome (mRS scoring 0-2) at 6-month follow-up. Follow-up angiography displayed that one case of recurrence occurred separately in both groups. Fifteen of the 33 hemorrhagic patients (45.5%) and 19 of the 37 ischemic patients (51.4%) rated QOL at follow-up as bad (SS-QOL score ≤ 3.9) despite a good functional outcome. Severity of neurological disorder and impaired neurocognition at baseline in VADA patients are proved to be independent predictors for the decline of QOL according to regression analysis. Conclusion: Reconstructive endovascular therapy for acute intracranial VADAs is a safe and effective method with a low complication rate. VADAs lead to impaired QOL Gao et al. Quality of Life in VADAs Reconstructive Therapy at 6-month follow-up, which is attributable to multiple factors. This study demonstrated that neurological and cognitive status at baseline is of significant importance for QOL after VADAs.

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Safety of Unilateral Endovascular Occlusion of the Cervical Segment of the Vertebral Artery without Antecedent Balloon Test Occlusion

Cited by 29 publications

References 18 publications

Surgery of cervical spine tumors in the close vicinity to the vertebral artery: literature review

Surgery of cervical spine tumors in the close vicinity to the vertebral artery: literature review

Fusiform vertebral artery aneurysms involving the posterior inferior cerebellar artery origin associated with the sole angiographic anterior spinal artery origin: technical case report and treatment paradigm proposal

Clinical Efficacy and Quality of Life Follow-Up of Reconstructive Endovascular Therapy for Acute Intracranial Vertebral Artery Dissection Aneurysms

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