Vertebrobasilar artery

Han DH, Kwon OK, Oh CW. Clinical characteristics of vertebrobasilar artery dissection. Neurol Med Chir Tokyo) 1998 38(SuppL) 107-113. 

Several case series have described angioplasty and stenting of symptomatic vertebral and basilar stenosis (Cloud et al. 2003) (Figs. 26.2 and 26.3 see also Fig. 12.4). A recent review (Eberhardt et al. 2006) of more than 600 cases published up to 2005 provides useful information on perioperative complication rates, particularly the difference in complication rates in treatment of proximal versus distal vertebrobasilar artery lesions. In early studies, proximal lesions were treated primarily with angioplasty, but this was associated with restenosis in 15-31% of patients after 15 to 30 months of follow-up. More recently, stenting has been used for the proximal vertebral system, especially ostial lesions. Several series have reported low periprocedural or post-interventional stroke rates (Eberhardt et al. 2006). 

Kwori SU, Koh lY, Kim IS (1999) Vertebrobasilar artery tenitory infaredon as an ini dal manifestadon of systemic lupus erydrematosus. Clirr Neurol Neurosurg 101(1) 62-67. 

Kwon SU, Koh JY, Kim JS (1999) Vertebrobasilar artery territory infarction as an initial manifestation of systemic lupus erythematosus. Clin Neurol Neurosurg 101(l) 62-67. 

Observational studies In a case-control and case-crossover study there was no difference in the risk of vertebrobasilar artery stroke associated with chiropractic care and primary care [128. ... 

Dissection of the internal carotid and vertebral arteries is a common cause of stroke, particularly in young patients. Although many occur due to trauma, it is estimated that over half occur spontaneously. The mechanism of stroke following arterial dissection is either by artery-to-artery embolism, by thrombosis in situ, or by dissection-induced lumenal stenosis with secondary cerebral hypoperfusion and low-flow watershed infarction. Occasionally, dissection may lead to the formation of a pseudoaneurysm as a source of thrombus formation. Vertebrobasilar dissections that extend intracranially have a higher risk of rupture leading to subarachnoid hemorrhage (SAH). ° ... 

Basilar artery or vertebrobasilar migraine is not an uncommon type of migraine. Often young woman... 

Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19 1216-1222... 

Atherosclerosis mainly affects large- and mediumsized arteries. Extracranial manifestations at the carotid bifurcation statistically dominate the intracranial arteries. Besides typical manifestations at the carotid siphon or the vertebrobasilar junction, atherosclerosis is occasionally also found in peripheral intracranial vessel segments. Typical sequelae of atherosclerosis are stenosing plaque formations, ulcerations, dilatations or the evolution of fusiform aneurysms, which can be accompanied by extensive formation of thrombus. 

The most feared vertebrobasilar stroke is occlusion of the basilar artery. Patients with lesions in the basilar artery are five times more likely to have a poor outcome independent of other factors (Glass et al. 2002). The importance of its early recognition is the possibility of performing intra-arterial throm-... 

Around the orbit. Branches of the external carotid artery can anastomose with branches of the ophthalmic artery if the internal carotid artery is severely stenosed or obstructed. Collateral flow from the external carotid artery into the orbit then passes retrogradely through the ophthalmic artery to fill the carotid siphon, middle cerebral artery and anterior cerebral artery. Sometimes flow may even reach the posterior cerebral artery and vertebrobasilar system. 

Vertebrobasilar insufficiency in rheumatoid atlanto-axial subluxation a case report with angiographic demonstration of left vertebral artery occlusion. Journal of Neurology 235 189-190... 

The symptoms of a TIA enable categorization of attacks by arterial territory affected carotid in approximately 80% or vertebrobasilar in 20%. This has important implications for further investigation and secondary prevention. Such categorization may be straightforward where there are definite cortical symptoms such as dysphasia or brainstem symptoms such as diplopia. However, because the motor and sensory pathways are supplied by both vascular systems at different points in their course, it is not always possible to distinguish which territory is involved (Table 8.1). One study found that the... 

ICA, the MCA stem, the branch points of the major MCA branches, the ACA, A1 and A2 branches, the PI and P2 segment of the PCA, the distal vertebral artery, the vertebral artery origin, the vertebrobasilar junction, and the basilar artery. Microatherosclerotic plaques can occur as described above in the proximal portion of the penetrator arteries arising from the major vessels at the base of the brain. They are not seen in the leptomeningeal vessels over the cortex [20]. 

Additional common sites for atherosclerotic occlusion include the origin of the vertebral artery, the distal vertebral and vertebrobasilar junction, the midbasilar artery, and the proximal PCA. Unlike ICA disease, severe atherosclerotic stenosis in the distal intracranial vertebral and basilar arteries can cause stroke via thrombotic occlusion of local branches as well as artery-to-artery embolus to the top of the basilar artery or the PCA(s). Low flow in the basilar artery can lead to thrombus formation with occlusion of one brainstem penetrator vessel after another. Basilar thrombosis is not rare and is fatal because brainstem function is completely dependent on this vascular supply [20, 23]. 

SchelUnger PD, Fiebach JB, Mohr A et al (2001) Thrombolytic therapy for ischemic stroke-a review. Part Il-Intra-arterial thrombolysis, vertebrobasilar stroke, phase IV trials, and stroke imaging. Crit Care Med 29 1819-1825... 

Eckert, B., Koch, C., ThomaUa, G., Kucinski, T, Grzyska, U., Roether, J., Alfke, K., Jansen, O., and Zeumer, H. (2005) Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST) results of a multicenter study. Stroke, 36 1160-1165. 

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