Endovascular treatment for vertebral artery stenosis ectopic originating from aortic arch: clinical data analysis of 5 patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Yiren , CUI Shijun , YANG Shengjia , TONG Zhu , GUO Jianming , GU Yongquan ,  GUO Lianrui

Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;

Corresponding?author：

GUO Lianrui, Email: 1044832160@qq.com

Keywords：

ectopic vertebral artery; vertebral artery stenosis; stent implantation

DOI：

10.7507/1007-9424.202404123

Video：

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Objective To summarize the feasibility and effectiveness of endovascular treatment for vertebral artery stenosis ectopic originating from the aortic arch. Method The clinical data of 5 patients with vertebral artery stenosis ectopic originating from aortic arch admitted to Xuanwu Hospital of Capital Medical University from January 2020 to May 2023 were retrospectively analyzed. Results All 5 patients underwent magnetic resonance angiography and CT angiography before treatment. The vertebral arteries of all patients originated from the aortic arch and were severe stenosis, with a median diameter of 1.3 mm (range, 1.1–1.5 mm) by CT angiography. All 5 patients were successfully treated with endovascular intervention. The operation time was 37–45 min, with a median of 39 min. There were no complications of vertebral artery rupture, embolism or occlusion, cerebral infarction, plaque abscission, hematoma at puncture site, pseudoaneurysm, postoperative hemorrhage, or perioperative pulmonary infection. The patients were followed-up for 13–30 months, with a median follow-up time of 20 months. The blood vessels of 5 patients remained unobstructed and no clinically significant vascular restenosis occurred. Conclusions Based on the experiences of 5 cases of vertebral artery stenosis ectopic originating from the aortic arch, it is safe and effective to choose endovascular treatment for severe symptomatic vertebral artery stenosis. Especially, it is necessary to evaluate the stenosis degree of vertebral artery using CT angiography before treatment.

Citation： LIU Yiren, CUI Shijun, YANG Shengjia, TONG Zhu, GUO Jianming, GU Yongquan, GUO Lianrui. Endovascular treatment for vertebral artery stenosis ectopic originating from aortic arch: clinical data analysis of 5 patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(10): 1246-1250. doi: 10.7507/1007-9424.202404123 Copy

1.	do Nascimento DWB, da Cruz RMM, Pimenta GGD, et al. Dual origin of vertebral artery and intimal relationship with spontaneous artery dissection: a case report and systematic review. Surg Radiol Anat, 2021, 43(3): 459-465.
2.	練沛榮, 陳虎, 易紅蕾, 等. 椎動脈枕下段走行變異分型及其臨床應用綜述. 中國臨床解剖學雜志, 2023, 41(6): 746-750.
3.	Bahadori M, Shojaei SF, Ashayeri R, et al. A case of aberrant bilateral vertebral arteries orgin presenting with right VA dissection. Caspian J Intern Med, 2020, 11(1): 116-119.
4.	Yaprak F, Ozer MA, Govsa F, et al. Variations of the extracranial segment of vertebral artery as a bleeding risk factor. Surg Radiol Anat, 2021, 43(10): 1735-1743.
5.	裴思蝶, 熊華花, 鄒霞, 等. 超聲在椎動脈起源異常中的診斷價值研究. 中國超聲醫學雜志, 2024, 40(4): 390-393.
6.	Omotoso BR, Harrichandparsad R, Moodley IG, et al. An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population. Surg Radiol Anat, 2021, 43(6): 929-941.
7.	Yuan SM. Aberrant origin of vertebral artery and its clinical implication. Braz J Cardiovasc Surg, 2015, 31(1): 52-59.
8.	Sikka A, Jain A. Bilateral variation in the origin and course of the vertebral artery. Anat Res Int, 2012, 2012: 580765. doi: 10.1155/2012/580765.
9.	郭春輝, 宋文慧. 椎動脈的解剖變異以及對頸椎手術影響的研究進展. 中國骨與關節雜志, 2023, 12(7): 556-560.
10.	Naylor R, Rantner B, Ancetti S, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the management of atherosclerotic carotid and vertebral artery disease. Eur J Vasc Endovasc Surg, 2023, 65(1): 7-111.
11.	Compter A, van der Worp HB, Algra A, et al. Prevalence and prognosis of asymptomatic vertebral artery origin stenosis in patients with clinically manifest arterial disease. Stroke, 2011, 42(10): 2795-2800.
12.	Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke, 2021, 52(7): e364-e467. doi: 10.1161/STR.0000000000000375.
13.	AbuRahma AF, Avgerinos ED, Chang RW, et al. Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease. J Vasc Surg, 2022, 75(1S): 4S-22S. doi: 10.1016/j.jvs.2021.04.073.
14.	范芳芳, 霍勇. H型高血壓: 我國腦卒中一級預防的關鍵. 新醫學, 2024, 55(4): 243-247.
15.	李震, 張林楓. 椎動脈開口狹窄診療的進展與爭議. 中國血管外科雜志(電子版), 2024, 16(1): 11-16.
16.	楊根歡, 廖鵬志, 汪巖, 等. 開放手術重建顱外段椎動脈的療效分析. 中國醫學科學院學報, 2023, 45(2): 251-256.
17.	楊根歡, 汪巖, 廖鵬志, 等. 椎動脈狹窄患者行開放手術治療的臨床分析: 附6例報道. 中國普外基礎與臨床雜志, 2020, 27(9): 1117-1120.
18.	Kim SH, Lee JS, Kwon OK, et al. Prevalence study of proximal vertebral artery stenosis using high-resolution contrast-enhanced magnetic resonance angiography. Acta Radiol, 2005, 46(3): 314-321.
19.	劉一人, 谷涌泉, 郭連瑞. 藥涂球囊在腎動脈型大動脈炎治療中的應用. 中國普外基礎與臨床雜志, 2024, 31(4): 439-443.
20.	Li L, Wang X, Yang B, et al. Validation and comparison of drug eluting stent to bare metal stent for restenosis rates following vertebral artery ostium stenting: A single-center real-world study. Interv Neuroradiol, 2020, 26(5): 629-636.
21.	楊承東, 張賢軍, 宮文韜, 等. 藥物洗脫支架與金屬裸支架治療椎動脈開口狹窄的療效. 血管與腔內血管外科雜志, 2023, 9(3): 345-349.
22.	袁波, 譚莉, 黃曉松, 等. 遠端保護裝置下血管內治療椎動脈開口狹窄. 腦與神經疾病雜志, 2016, 24(1): 27-31.
23.	馮瑤, 李龍, 宋剛, 等. 中國顱外段椎動脈支架置入術的文獻評價與現狀. 中國腦血管病雜志, 2019, 16(6): 316-320.
24.	Kohta M, Fujita A, Yamashita S, et al. Ultrasonographically-guided stent placement at the vertebral artery origin without contrast medium: A case report. J Clin Ultrasound, 2020, 48(6): 362-366.
25.	景良, 許學杰, 羅軍, 等. 椎動脈狹窄術后再次狹窄的相關因素分析. 大醫生, 2023, 8(7): 94-96.

1. do Nascimento DWB, da Cruz RMM, Pimenta GGD, et al. Dual origin of vertebral artery and intimal relationship with spontaneous artery dissection: a case report and systematic review. Surg Radiol Anat, 2021, 43(3): 459-465.
2. 練沛榮, 陳虎, 易紅蕾, 等. 椎動脈枕下段走行變異分型及其臨床應用綜述. 中國臨床解剖學雜志, 2023, 41(6): 746-750.
3. Bahadori M, Shojaei SF, Ashayeri R, et al. A case of aberrant bilateral vertebral arteries orgin presenting with right VA dissection. Caspian J Intern Med, 2020, 11(1): 116-119.
4. Yaprak F, Ozer MA, Govsa F, et al. Variations of the extracranial segment of vertebral artery as a bleeding risk factor. Surg Radiol Anat, 2021, 43(10): 1735-1743.
5. 裴思蝶, 熊華花, 鄒霞, 等. 超聲在椎動脈起源異常中的診斷價值研究. 中國超聲醫學雜志, 2024, 40(4): 390-393.
6. Omotoso BR, Harrichandparsad R, Moodley IG, et al. An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population. Surg Radiol Anat, 2021, 43(6): 929-941.
7. Yuan SM. Aberrant origin of vertebral artery and its clinical implication. Braz J Cardiovasc Surg, 2015, 31(1): 52-59.
8. Sikka A, Jain A. Bilateral variation in the origin and course of the vertebral artery. Anat Res Int, 2012, 2012: 580765. doi: 10.1155/2012/580765.
9. 郭春輝, 宋文慧. 椎動脈的解剖變異以及對頸椎手術影響的研究進展. 中國骨與關節雜志, 2023, 12(7): 556-560.
10. Naylor R, Rantner B, Ancetti S, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the management of atherosclerotic carotid and vertebral artery disease. Eur J Vasc Endovasc Surg, 2023, 65(1): 7-111.
11. Compter A, van der Worp HB, Algra A, et al. Prevalence and prognosis of asymptomatic vertebral artery origin stenosis in patients with clinically manifest arterial disease. Stroke, 2011, 42(10): 2795-2800.
12. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke, 2021, 52(7): e364-e467. doi: 10.1161/STR.0000000000000375.
13. AbuRahma AF, Avgerinos ED, Chang RW, et al. Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease. J Vasc Surg, 2022, 75(1S): 4S-22S. doi: 10.1016/j.jvs.2021.04.073.
14. 范芳芳, 霍勇. H型高血壓: 我國腦卒中一級預防的關鍵. 新醫學, 2024, 55(4): 243-247.
15. 李震, 張林楓. 椎動脈開口狹窄診療的進展與爭議. 中國血管外科雜志(電子版), 2024, 16(1): 11-16.
16. 楊根歡, 廖鵬志, 汪巖, 等. 開放手術重建顱外段椎動脈的療效分析. 中國醫學科學院學報, 2023, 45(2): 251-256.
17. 楊根歡, 汪巖, 廖鵬志, 等. 椎動脈狹窄患者行開放手術治療的臨床分析: 附6例報道. 中國普外基礎與臨床雜志, 2020, 27(9): 1117-1120.
18. Kim SH, Lee JS, Kwon OK, et al. Prevalence study of proximal vertebral artery stenosis using high-resolution contrast-enhanced magnetic resonance angiography. Acta Radiol, 2005, 46(3): 314-321.
19. 劉一人, 谷涌泉, 郭連瑞. 藥涂球囊在腎動脈型大動脈炎治療中的應用. 中國普外基礎與臨床雜志, 2024, 31(4): 439-443.
20. Li L, Wang X, Yang B, et al. Validation and comparison of drug eluting stent to bare metal stent for restenosis rates following vertebral artery ostium stenting: A single-center real-world study. Interv Neuroradiol, 2020, 26(5): 629-636.
21. 楊承東, 張賢軍, 宮文韜, 等. 藥物洗脫支架與金屬裸支架治療椎動脈開口狹窄的療效. 血管與腔內血管外科雜志, 2023, 9(3): 345-349.
22. 袁波, 譚莉, 黃曉松, 等. 遠端保護裝置下血管內治療椎動脈開口狹窄. 腦與神經疾病雜志, 2016, 24(1): 27-31.
23. 馮瑤, 李龍, 宋剛, 等. 中國顱外段椎動脈支架置入術的文獻評價與現狀. 中國腦血管病雜志, 2019, 16(6): 316-320.
24. Kohta M, Fujita A, Yamashita S, et al. Ultrasonographically-guided stent placement at the vertebral artery origin without contrast medium: A case report. J Clin Ultrasound, 2020, 48(6): 362-366.
25. 景良, 許學杰, 羅軍, 等. 椎動脈狹窄術后再次狹窄的相關因素分析. 大醫生, 2023, 8(7): 94-96.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Endovascular treatment for vertebral artery stenosis ectopic originating from aortic arch: clinical data analysis of 5 patients

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