Endovascular treatment for ectopic 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 University of Medical Sciences, 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 operation. 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). 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 use CT angiography to evaluate the stenosis degree of vertebral artery before operation.

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.	练沛荣, 陈虎, 易红蕾, 等. 椎动脉枕下段走行变异分型及其临床应用综述. 中国临床解剖学杂志, 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, 熊华花, 邹霞, 等. 超声在椎动脉起源异常中的诊断价值研究. 中国超声医学杂志, 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.	郭春辉, 宋文慧. 椎动脉的解剖变异以及对颈椎手术影响的研究进展. 中国骨与关节杂志, 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型高血压: 我国脑卒中一级预防的关键. 新医学, 2024, 55(4): 243-247.
15.	李震, 张林枫. 椎动脉开口狭窄诊疗的进展与争议. 中国血管外科杂志(电子版), 2024, 16(1): 11-16.
16.	杨根欢, 廖鹏志, 汪岩, 等. 开放手术重建颅外段椎动脉的疗效分析. 中国医学科学院学报, 2023, 45(2): 251-256.
17.	杨根欢, 汪岩, 廖鹏志, 等. 椎动脉狭窄患者行开放手术治疗的临床分析: 附6例报道. 中国普外基础与临床杂志, 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.	刘一人, 谷涌泉, 郭连瑞. 药涂球囊在肾动脉型大动脉炎治疗中的应用. 中国普外基础与临床杂志, 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.	杨承东, 张贤军, 宫文韬, 等. 药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的疗效. 血管与腔内血管外科杂志, 2023, 9(3): 345-349.
22.	袁波, 谭莉, 黄晓松, 等. 远端保护装置下血管内治疗椎动脉开口狭窄. 脑与神经疾病杂志, 2016, 24(1): 27-31.
23.	冯瑶, 李龙, 宋刚, 等. 中国颅外段椎动脉支架置入术的文献评价与现状. 中国脑血管病杂志, 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, 许学杰, 罗军, 等. 椎动脉狭窄术后再次狭窄的相关因素分析. 大医生, 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. 练沛荣, 陈虎, 易红蕾, 等. 椎动脉枕下段走行变异分型及其临床应用综述. 中国临床解剖学杂志, 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, 熊华花, 邹霞, 等. 超声在椎动脉起源异常中的诊断价值研究. 中国超声医学杂志, 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. 郭春辉, 宋文慧. 椎动脉的解剖变异以及对颈椎手术影响的研究进展. 中国骨与关节杂志, 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型高血压: 我国脑卒中一级预防的关键. 新医学, 2024, 55(4): 243-247.
15. 李震, 张林枫. 椎动脉开口狭窄诊疗的进展与争议. 中国血管外科杂志(电子版), 2024, 16(1): 11-16.
16. 杨根欢, 廖鹏志, 汪岩, 等. 开放手术重建颅外段椎动脉的疗效分析. 中国医学科学院学报, 2023, 45(2): 251-256.
17. 杨根欢, 汪岩, 廖鹏志, 等. 椎动脉狭窄患者行开放手术治疗的临床分析: 附6例报道. 中国普外基础与临床杂志, 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. 刘一人, 谷涌泉, 郭连瑞. 药涂球囊在肾动脉型大动脉炎治疗中的应用. 中国普外基础与临床杂志, 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. 杨承东, 张贤军, 宫文韬, 等. 药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的疗效. 血管与腔内血管外科杂志, 2023, 9(3): 345-349.
22. 袁波, 谭莉, 黄晓松, 等. 远端保护装置下血管内治疗椎动脉开口狭窄. 脑与神经疾病杂志, 2016, 24(1): 27-31.
23. 冯瑶, 李龙, 宋刚, 等. 中国颅外段椎动脉支架置入术的文献评价与现状. 中国脑血管病杂志, 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, 许学杰, 罗军, 等. 椎动脉狭窄术后再次狭窄的相关因素分析. 大医生, 2023, 8(7): 94-96.

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