Vertebral artery atherosclerosis: a risk factor in the use of manipulative therapy?

Abstract

These data suggest that, as significant numbers of the sample showed marked (Grade 3+) atherosclerosis, concomitant with decreased blood flow in the vertebral arteries, this population is at risk for developing vertebrobasilar insufficiency. Because other Western populations may be similarly at risk, particular care should be taken when considering the use of rotational manipulative therapy techniques in treatments of the cervical spine.

Manual Therapy and Cervical Arterial Dysfunction, Directions for the Future: A Clinical Perspective

“…Few studies have measured blood fl ow in the intracranial VA 21,23,24,28 where it may be argued that VA blood fl ow related to the upper cervical spine would be a more accurate measure of fl ow change 24,32,73,74 . It has also been shown that VA atherosclerotic plaques do exist throughout the course of the VA 64 . On the other hand, ICA plaques are most prevalent around the bifurcation of the internal/external vessels, this is usually around the mid/low cervical spine, around the bifurcation of the common carotid artery 81 .…”

“…heart disease, stroke, transient ischemic attack, peripheral vascular disease); smoking, high serum low density lipoprotein (hypercholesterolemia/hyperlipidemia/high cholesterol-high fat diet); hyperhomocysteinemia; infection by escherichia coli, helicobacter pylori, chlamydia pneumoniae, streptococcus, staphylococcus, salmonella, clostridium, mycobacterium, fungi, yersenia, treponema; and mechanical trauma to vessel [46][47][48][49][50][51][52][53][54][55] . The logic for considering this in cervical MT is simple and is based on the following premises: 1) Atherosclerosis is strongly linked with localized ICA [56][57][58][59] and VA [60][61][62][63][64] dysfunction, and ultimately stroke as a result of this localized dysfunction. 2) Cervical movement affects blood fl ow in these vessels (see above).…”

Hypoplastic vertebral artery: frequency and associations with ischaemic stroke territory

“…Although there is no clear definition of HVA, it was defined as a vertebral artery with a diameter of (2 mm, and the larger (contralateral) one was defined as a dominant vertebral artery in this study. We chose to examine the midportion level of V 2 (the portion in the vertebral columns) of the vertebral artery using magnified images of MRA on a picture archiving communication system because other levels, including V 3 (after exit from the C2 transverse foramen), 10 V 4 (the intracranial portion beginning at the atlanto-occipital membrane and terminating at the formation of the basilar artery) 10 and V 1 (proximal to entry into the transverse foramen), are more susceptible to atherosclerotic steno-occlusion or have more artefacts than V 2 . We initially evaluated TOF, but when steno-occlusion or hypoplasia was obscure, we further used contrast-enhanced MRA with same magnetic resonance sequence as that of TOF in ,5% of stroke cases.…”

“…The HVA frequency of those with ACS was similar to that of the normal group (26.5%). Of the 112 patients with vertebral artery territory stroke, 58 (51.8%) had HVA (bilateral HVA in 10), and all of 48 showed ipsilateral HVA territory stroke. In 102 patients with vertebral artery territory stroke, classification of the ipsilateral vertebral artery as hypoplastic (vs dominant or symmetric) tended to predict the involvement of multiple and extensive lesions, and a higher incidence of steno-occlusion (p,0.001).…”

Doppler insonation of vertebral artery blood flow changes associated with cervical spine rotation: Implications for manual therapists

“…atlanto-axial loop) (Johnson and Burns, 1993;Johnson, Baugh, Wilson, and Burns, 2001), and histopathological changes such as atherosclerosis (Ross, 1999;Mitchell, 2002) are known to occur in vessels with increasing age. Such factors may affect blood flow directly or indirectly (particularly with cervical spine movements).…”