No abstract available.
Vertebrobasilar Insufficiency

No abstract available.
Vertebral Artery ; Vertebrobasilar Insufficiency

OBJECTIVE: To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis. METHODS: A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles. RESULTS: In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, =0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; = 629.5, =0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) 7.7%(3/39);=8.603, =0.003). CONCLUSIONS SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome.
Hemodynamics ; Humans ; Regional Blood Flow ; physiology ; Retrospective Studies ; Subclavian Steal Syndrome ; complications ; physiopathology ; Vertebral Artery ; physiopathology ; Vertebrobasilar Insufficiency ; complications ; physiopathology

A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally significant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insufficiency symptoms due to reversal of blood flow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 mmHg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.
Angioplasty ; Arm ; Basilar Artery ; Blood Pressure ; Cardiovascular Diseases ; Constriction, Pathologic ; Humans ; Male ; Peripheral Vascular Diseases ; Stents ; Subclavian Artery ; Subclavian Steal Syndrome ; Upper Extremity ; Vertebral Artery ; Vertebrobasilar Insufficiency

BACKGROUNDEndovascular therapy is a treatment option for localized occlusion of the subclavian artery. In this report the long-term experience with 59 patients is presented.

METHODSBetween June 1998 and September 2008, we used endovascular therapy to treat 61 subclavian arterial obstructive lesions in 59 patients (46 males and 13 females, 34 - 82 years of age with a mean age (61.9 + or - 11.0) years). Twenty patients (34%) had clinical symptoms due to vertebrobasilar insufficiency, 26 (44%) had disabling arm ischemia, and 13 (22%) had both symptoms. We performed all procedures under local anesthesia. The approaches were from the femoral artery (n = 47), brachial artery (n = 1, involving bilateral subclavian disease) or both (n = 11). Sixty stents were implanted. All patients were followed-up at 1, 3, 6, and 12 months post-procedure, and annually thereafter.

RESULTSWe achieved technical success in 58 (95.1%) arteries, all of which were stented. There were three technical failures; two were due to the inability to cross over an occlusion, necessitating the switch to an axillo-axillary bypass, and the third was due to shock after digital subtraction angiography and prior to stenting. Arterial stenosis pre- and post-stenting was (83.6 + or - 10.8)% and (2.5 + or - 12.5)% (P < 0.01). Clinical success was achieved in 55 of the 59 patients (93.4%). Of the four clinical failures, three were technical and the remaining patient had a stent thrombosis. Systolic blood pressure difference between the two brachial arteries was (44.7 + or - 18.5) vs. (2.2 + or - 3.9) mmHg (P < 0.01). Primary patency was 98% at 12 months, 93% at 24 months, and 82% at 5 years. Five patients were lost to follow-up by 12 months post-stenting. Significant recurrent obstruction developed in five patients with resumption of clinical symptoms. The overall survival rate was 98.2% at 12 months, 89.5% at 24 months, and 84.5% at 5 years.

CONCLUSIONSEndovascular therapy for proximal subclavian arterial obstructive lesions is effective and successful. This minimally invasive treatment may be the first choice of treatment for proximal subclavical arterial obstructive lesions.

Adult ; Aged ; Aged, 80 and over ; Arterial Occlusive Diseases ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stents ; Subclavian Artery ; pathology ; Subclavian Steal Syndrome ; pathology ; therapy ; Vertebrobasilar Insufficiency ; pathology ; therapy

The nystagmus of vertebrobasilar insufficiency (VBI) patients is not clearly understood. In this article we report a videonystagmography (VNG) result which had been recorded in a VBI patient during his ictal period. The spontaneous nystagmus was purely torsional toward the left side. During the various positional tests, up beating left torsional and right horizontal nystagmus was found. Right beating horizontal nystagmus was stronger when the head was turned to the left side. But we were not able to explain the exact mechanism of this nystagmus. Although the mechanism is not fully understood the pattern of nystagmus reported in this article may be helpful in distinguishing VBI from other diseases by means of VNG recording.
Head ; Humans ; Nystagmus, Pathologic ; Vertebrobasilar Insufficiency ; Vertigo

BACKGROUND AND OBJECTIVES: The present study investigated the role of the peripheral vestibular end organ in vestibular symptoms and temporal changes in expression of c-Fos protein in the vestibular nuclei following anterior inferior cerebellar artery (AICA) occlusion using rats with unilateral or bilateral labyrinthectomy. MATERIALS AND METHODS: Expression of c-Fos protein in the vestibular nuclei was measured 2, 12, 24, and 48 hours after AICA occlusion. RESULTS: Unilateral AICA occlusion significantly induced expression of c-Fos protein bilaterally in the medial, inferior, superior, and lateral vestibular nuclei. Following AICA occlusion, the medial vestibular nucleus (MVN) showed the highest expression of c-Fos protein among the 4 vestibular nuclei. The expression of c-Fos protein was asymmetric between the bilateral MVN, showing higher expression in the MVN contralateral to the side of AICA occlusion compared to the ipsilateral MVN. The degree of asymmetry in c-Fos protein expression between the bilateral MVN peaked 12 hours after AICA occlusion. The expression of c-Fos protein gradually decreased 24 hours after AICA occlusion and returned to control levels 48 hours after AICA occlusion. Unilateral labyrinthectomy significantly decreased expression of c-Fos protein in the MVN ipsilateral to the side of labyrinthectomy following AICA occlusion. Moreover, bilateral labyrinthectomy significantly decreased expression of c-Fos protein in the bilateral MVN flowing AICA occlusion. CONCLUSION: These results suggest that afferent signals from the peripheral vestibular end organ are crucial to the expression of c-Fos protein in the MVN following AICA occlusion and that expression of c-Fos protein is sustained for 24 hours after AICA occlusion.
Animals ; Arteries ; Rats ; Vertebrobasilar Insufficiency ; Vestibular Nuclei

Bow hunter's syndrome (BHS) is rare cause of vertebrobasilar insufficiency that arises from mechanical compression of the vertebral artery by head rotation. There is no standardized diagnostic regimen or treatment of BHS. Recently, we experienced 2 cases resisted continues medication and treated by surgical approach. In both cases, there were no complications after surgery and there were improvements in clinical symptoms. Thus, we describe our cases with surgical decompression with a review of the relevant medical literature.
Decompression ; Decompression, Surgical ; Head ; Mucopolysaccharidosis II* ; Vertebral Artery* ; Vertebrobasilar Insufficiency

Vertebrobasilar insufficiency can be caused by proximal vertebral artery (VA) occlusion. Performing endovascular recanalization for treating VA occlusion has high procedural risks, including vessel perforation. In contrast, surgical revascularization of the distal extracranial VA had been used for many decades to treat proximal VA occlusion or stenosis, and its safety and satisfactory long-term outcome are well established. We report here on a case of successful surgical revascularization by performing occipital artery to distal extracranial VA bypass for bilateral proximal VA occlusion and we discuss its potential role for the treatment of medical refractory recurrent ischemia in the vertebrobasilar territory
Arteries ; Constriction, Pathologic ; Glycosaminoglycans ; Ischemia ; Vertebral Artery ; Vertebrobasilar Insufficiency

Vertebrobasilar insufficiency (VBI) in rotatory vertebral artery occlusion syndrome can be caused by voluntary head turning in the yaw plane. We report a case of VBI for head tilting in the roll plane. Transcranial Doppler on left head tilting resulted in decreased blood flow in both vertebral arteries. A CT angiogram revealed that the stenotic left vertebral artery was very close to an enlarged thyroid gland, suggesting mechanical compression of the vertebral artery during head tilt.
Head ; Thyroid Gland ; Vertebral Artery ; Vertebrobasilar Insufficiency ; Vertigo