Delineability and anatomical variations of perforating arteries from normal vertebral artery on 3D DSA: implications for
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INTERVENTIONAL NEURORADIOLOGY
Delineability and anatomical variations of perforating arteries from normal vertebral artery on 3D DSA: implications for endovascular treatment of dissecting aneurysms Shuichi Tanoue 1 & Hidenori Endo 2 & Masafumi Hiramatsu 3 & Yuji Matsumaru 4 & Yasushi Matsumoto 5 & Kenichi Sato 5 & Wataro Tsuruta 6 & Masayuki Sato 4 & Masaru Hirohata 7 & Toshi Abe 1 & Hiro Kiyosue 8 & on behalf of the JSNET VADA study group Received: 26 May 2020 / Accepted: 1 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background and Purpose Endovascular trapping of the vertebral artery dissecting aneurysms (VADAs) carries a risk of medullary infarction due to the occlusion of the perforating arteries. We evaluated the detectability and anatomical variations of perforating arteries arising from the vertebral artery (VA) using three-dimensional DSA. Methods In 120 patients without VA lesions who underwent rotational vertebral arteriography, the anatomical configurations of perforating arteries from the VA were retrospectively evaluated on the bi-plane DSA and reconstructed images to reach the consensus between two experienced reviewers. The images were interpreted by focusing on the numbers and types of perforating arteries, the relationships between the number of perforators and the anatomy of the VA and its branches. Results Zero, 1, 2, 3, 4, and 6 perforators were detected in 2, 51, 56, 9, 1, and 1 patient, respectively (median of 2 perforators per VA). The 200 perforators were classified into 146 terminal and 54 longitudinal course types and into 32 ventral, 151 lateral, and 17 dorsolateral distribution types. All ventral type perforators were also terminal type. In contrast, the longitudinal type was seen in 28.5% of lateral types and in 65% of dorsolateral types. Regarding the difference in the origin of the posterior inferior cerebellar artery (PICA), non-PICA type VAs gave off larger number of perforators than the other types of VAs. Conclusions Non-PICA type VAs give off a significantly larger number of perforators than other types, indicating that the trapping of non-PICA type VAs is associated with a risk of ischemic complications. Keywords Vertebral artery . Perforating artery . 3D DSA . Anatomical variation
Introduction Intracranial vertebral artery dissecting aneurysms (VADAs) are associated with acute ischemic stroke, subarachnoid hemorrhage, and other neurological symptoms [1]. A ruptured
* Shuichi Tanoue [email protected] 1
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Department of Radiology, Kurume University School of Medicine, Kurume, Japan Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
VADA is often followed by rebleeding, resulting in severe clinical outcomes in the acute stage [2, 3]. Therefore, early intervention is required to prevent rerupture of the VADA. Endovascular trapping of a ruptured
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