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ABSTRACT Objectives Methods Results Conclusions To minimize the risk of V3 segment of vertebral artery (VA) injury in the atlantoaxial dislocation (AAD) patients with C1 pedicle height less than 4.0 mm and provide a strong toggle force in irreducible AAD and revision surgery. We evaluated the feasibility of C1 “Zero Angle” screw (C1ZAS) and safe entry point with “in–out–in” technique as an alternative option for C1 pedicle screw (PS) in cases with AAD.Sixty‐one patients with AAD or atlantoaxial instability (AAI) (45 male and 16 female) who underwent cervical computed tomography and magnetic resonance imaging scans in our center between January 1, 2022 and December 31, 2023 were retrospectively reviewed. Measurements were made around the ideal trajectory and entry point of C1ZAS using computerized tomography (CT) and magnetic resonance imaging (MRI) in 61 patients. Radiographic measurements included (A) the distance from the recess to the transverse foramen (RTF); (B) the tricortical screw zone (TSZ); (C) the lateral mass height along the C1ZAS trajectory (LMH); (D) the screw length of C1ZAS (ZSL); (E) the screw length of C1 PS (PSL); (F) the distances from the recess to the dura (RD); (G) the distance from the recess to the spinal cord (RSC); (H) the distance from the inner of lateral mass to the spinal cord (ILMSC). During the period of January 1, 2022 to December 31, 2023, C1ZAS placement with “in–out–in” technique was used as an alternative option for C1 PS in 8 patients with AAD and unilateral/bilateral narrow C1 pedicles.The average RTF, TSZ, LMH, ZSL, RD, RSC, and ILMSC were 7.71, 6.14, 8.32, 33.23, 4.68, 10.02, and 2.91 mm respectively. The entry point of the C1ZAS was defined as the projection point of the inner of the recess to the posterior arch and the trajectory should be angled cephalad by 8.7° and medially by 0°. The 61 patients (122 sides) with AAD or AAI were classified into three groups: the low‐risk (76 sides, 62%), the intermedial‐risk (18 sides, 15%), and the high‐risk (28 sides, 23%) groups. Satisfactory C1ZAS placement and atlantoaxial reduction were achieved in all eight patients with AAD and unilateral/bilateral narrow C1 pedicles. No instance of C1ZAS placement‐related VA injury or dural laceration was observed.When the placement of C1 PS is not feasible in patients with AAD and unilateral/bilateral narrow C1 pedicles, C1ZAS placement with “in–out–in” technique can be considered an effective alternative option, providing tricortical or quadricortical purchase for rigid fixation of the atlas. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to analyze failed posterior fossa decompression (PFD) in patients with basilar invagination and atlantoaxial dislocation (BI‐AAD). Revision surgery in these patients is challenging and has been rarely reported. In addition, the anatomical variations of the vertebral artery increase the risk of revision surgery. Here, we introduce the implementation of a new type of one‐stage posterior revision surgery, whose difficulties and effects are summarized. Methods: A total of 21 patients with BI‐AAD who underwent PFD were retrospectively analyzed in our center from November 2017 to April 2021. The revision surgery in all patients was performed through the posterior approach. The Japanese Orthopaedic Association (JOA) score and the Short Term 12 (SF‐12) score were employed to evaluate the clinical symptoms and health status. The distance from the tip of the odontoid to Chamberlain's line (DCL), the atlantodental interval (ADI), the clivus‐canal angle (CCA), the diameter of the subarachnoid space (DSS), and the craniovertebral junction triangular area (CTA) were assessed radiographically. The pre‐ and postoperative results were compared by paired t test. Results: The data of 21 consecutive patients were reviewed, with an average follow‐up period of 28 ± 14 months. Postoperative imaging showed effectively reduced compression of BI‐AAD. No implant failure or neurovascular injury occurred. Eleven patients had vertebral artery abnormalities, but none had vertebral artery injury. All patients had evidence of bone fusion on the CT scan images within a 12‐month follow‐up period. The JOA and SF‐12 scores were significantly improved 1 year postoperatively (p < 0.001). Conclusion: Posterior surgery using the technique of interarticular distraction, fusion with cage grafting, and fixation is a safe and effective revision surgery to treat patients with basilar invagination and atlantoaxial dislocation who failed PFD, which will result in good outcome. [ABSTRACT FROM AUTHOR]

Background: Strokes in young individuals often stem from unusual causes. Posterior circulation ischemic stroke caused by vertebral artery insufficiency due to atlantoaxial instability or dislocation is rare. We present a case of posterior circulation ischemic stroke due to an unstable os odontoideum and review the current literature. The clinical features and imaging manifestations are described to promote awareness of etiology, early diagnosis, and assessment. Case Presentation: A 24‐year‐old male presented with recurrent right‐sided limb numbness and weakness and cerebellar ataxia due to posterior circulation ischemic stroke. The work‐up revealed thrombosis reformation in the tortuous left vertebral artery. It is noteworthy that the patient developed compression and chronic damage of the vertebral artery secondary to atlantoaxial instability and lateral dislocation due to an os odontoideum. He underwent antiplatelet and anticoagulant therapy, cervical traction, and posterior atlantoaxial screw fixation and fusion with iliac crest autograft. The postoperative course was uneventful. At 6‐month follow‐up, the patient had a solid fusion mass and rigid stability of the atlantoaxial joint without neurologic deficits or ischemic sequelae. Conclusions: For unexplained posterior circulation ischemic stroke, it is important to consider unstable os odontoideum as a potential etiology, especially in pediatric and young adult male patients. Atlantoaxial instability and dislocation with os odontoideum, especially when occurring laterally, may cause insufficiency of the vertebral artery and subsequent posterior circulation ischemic strokes. The significance of lateral atlantoaxial dislocation in the genesis of vertebral artery injury and the necessity for specific positional imaging are emphasized. [ABSTRACT FROM AUTHOR]

Background and Purpose Experimental Approach Key Results Conclusions and Implications Intracranial atherosclerosis is one of the most common causes of ischaemic stroke. However, there is a substantial knowledge gap on the development of intracranial atherosclerosis. Intracranial arteries are characterized by an upregulation of tight junctions between endothelial cells, which control endothelial permeability. We investigated the role of N6‐methyladenosine (m6A), a common RNA modification, on endothelial integrity, focusing on the pro‐atherogenic microRNA miR‐494‐3p and tight junction proteins TJP1 and PECAM1.We assessed the m6A landscape, along with the expression of miR‐494‐3p, TJP1 and PECAM1 in postmortem human vertebral arteries (VA), internal carotid arteries (ICA), and middle cerebral arteries (MCA) with various stages of intimal thickening and plaque formation. The interactions between m6A‐modified miR‐494‐3p mimics, TJP1 and PECAM1, were investigated in vitro using primary human (brain) endothelial cells.Increased m6A expression was observed in the luminal lining of atherosclerosis‐affected VAs, accompanied by reduced TJP1 and PECAM1, but not VE‐cadherin, expression. Colocalization of m6A and miR‐494‐3p in the luminal lining of VA plaques was confirmed, indicating m6A methylation of miR‐494‐3p in intracranial atherosclerosis. Moreover, site‐specific m6A‐modification of miR‐494‐3p led to repression specifically of TJP1 protein expression at cell–cell junctions of brain microvascular endothelial cells, while unmodified miR‐494‐3p showed no effect.This study highlights increasing m6A levels during intracranial atherogenesis. Increases in m6A‐miR‐494‐3p contribute to the observed decreased TJP1 expression in endothelial cell–cell junctions. This is likely to have a negative effect on endothelial integrity and may thus accelerate intracranial atherosclerosis progression. [ABSTRACT FROM AUTHOR]

Aim: How the cerebral metabolic rates of oxygen and glucose utilization (CMRO2 and CMRGlc, respectively) are affected by alterations in arterial PCO2 (PaCO2) is equivocal and therefore was the primary question of this study. Methods: This retrospective analysis involved pooled data from four separate studies, involving 41 healthy adults (35 males/6 females). Participants completed stepwise steady‐state alterations in PaCO2 ranging between 30 and 60 mmHg. The CMRO2 and CMRGlc were assessed via the Fick approach (CBF × arterial‐internal jugular venous difference of oxygen or glucose content, respectively) utilizing duplex ultrasound of the internal carotid artery and vertebral artery to calculate cerebral blood flow (CBF). Results: The CMRO2 was altered by 0.5 mL × min−1 (95% CI: −0.6 to −0.3) per mmHg change in PaCO2 (p < 0.001) which corresponded to a 9.8% (95% CI: −13.2 to −6.5) change in CMRO2 with a 9 mmHg change in PaCO2 (inclusive of hypo‐ and hypercapnia). The CMRGlc was reduced by 7.7% (95% CI: −15.4 to −0.08, p = 0.045; i.e., reduction in net glucose uptake) and the oxidative glucose index (ratio of oxygen to glucose uptake) was reduced by 5.6% (95% CI: −11.2 to 0.06, p = 0.049) with a + 9 mmHg increase in PaCO2. Conclusion: Collectively, the CMRO2 is altered by approximately 1% per mmHg change in PaCO2. Further, glucose is incompletely oxidized during hypercapnia, indicating reductions in CMRO2 are either met by compensatory increases in nonoxidative glucose metabolism or explained by a reduction in total energy production. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Traumatic posterior atlantoaxial dislocation combined with Jefferson fracture and odontoid process fracture with vertebral artery injury is rare. The management of such injury raises controversial issues and is still open to debate. A 74‐year‐old Chinese male presented with sustained neck pain and stiffness after falling from height. The patient was neurologically intact. Preoperative radiographs demonstrated a Jefferson burst fracture with a posterior dislocation of the atlantoaxial joints and odontoid process Anderson and D'alonzo type II fracture. A computed tomography angiography (CTA) showed an occluded left vertebral artery. Coil embolization in the proximal portion of the occluded vertebral artery was performed to prevent further cerebral infarction due to distal embolization of the thrombus. Then a second stage occipito‐cervical fusion was performed to reconstruct cervical spine stability. A systematic screening of blunt trauma vertebral artery injuries through CTA is required when dealing with upper cervical fracture. For cases with vertebral artery occlusion secondary to cervical spine injury, endovascular treatment preceding cervical spine surgery is a feasible and a safe treatment. [ABSTRACT FROM AUTHOR]

Arterial spin labeling (ASL) has been widely used to evaluate arterial blood and perfusion dynamics, particularly in the brain, but its application to the spinal cord has been limited. The purpose of this study was to optimize vessel‐selective pseudocontinuous arterial spin labeling (pCASL) for angiographic and perfusion imaging of the rat cervical spinal cord. A pCASL preparation module was combined with a train of gradient echoes for dynamic angiography. The effects of the echo train flip angle, label duration, and a Cartesian or radial readout were compared to examine their effects on visualizing the segmental arteries and anterior spinal artery (ASA) that supply the spinal cord. Lastly, vessel‐selective encoding with either vessel‐encoded pCASL (VE‐pCASL) or super‐selective pCASL (SS‐pCASL) were compared. Vascular territory maps were obtained with VE‐pCASL perfusion imaging of the spinal cord, and the interanimal variability was evaluated. The results demonstrated that longer label durations (200 ms) resulted in greater signal‐to‐noise ratio in the vertebral arteries, improved the conspicuity of the ASA, and produced better quality maps of blood arrival times. Cartesian and radial readouts demonstrated similar image quality. Both VE‐pCASL and SS‐pCASL adequately labeled the right or left vertebral arteries, which revealed the interanimal variability in the segmental artery with variations in their location, number, and laterality. VE‐pCASL also demonstrated unique interanimal variations in spinal cord perfusion with a right‐sided dominance across the six animals. Vessel‐selective pCASL successfully achieved visualization of the arterial inflow dynamics and corresponding perfusion territories of the spinal cord. These methodological developments provide unique insights into the interanimal variations in the arterial anatomy and dynamics of spinal cord perfusion. [ABSTRACT FROM AUTHOR]

A 29-year-old man presented with right-limb weakness, numbness, and vertigo due to recurrent posterior circulation infarction caused by vertebral artery dissection secondary to atlas hypoplasia. The patient's symptoms were relieved after thrombolysis, but he later experienced memory loss and dullness. Imaging revealed acute infarctions in the thalamus, with the right vertebral artery more vulnerable due to atlas hypoplasia. Treatment included antithrombotic therapy and a dual antiplatelet regimen, leading to symptom relief. Vertebral artery dissection is a rare cause of ischemic stroke, with genetic and environmental factors contributing to its etiology. [Extracted from the article]

The internal jugular vein (IJV) is occasionally used for blood access during catheter ablation. Additionally, accidental injury of the vertebral artery during an IJV puncture is a rare complication that can result in catastrophic events, such as death. However, vascular access complications cannot be completely prevented despite the introduction of ultrasound‐guided punctures. Here, we present a case of a patient with symptomatic paroxysmal atrial fibrillation that required catheter ablation. [ABSTRACT FROM AUTHOR]

Background: Delayed migration and exposure of embolic coils is a rare complication of endovascular therapy for carotid blowout syndrome. Methods: A 64-year-old man with recurrent tongue cancer noticed the presence of foreign body in the malignant wound on the right side of his neck. He had undergone transarterial embolization on his right vertebral artery, right common carotid artery (CCA), and internal carotid artery (ICA) for carotid blowout syndrome 1 month prior. On physical examination, exposed spring-like metallic coils were observed, covered in brownish granulation tissue, at the bottom of the malignant wound. Neck radiograph and computed tomography confirmed the extrusion and migration of the embolic coils. Results: In this case, the patient was managed by transection of the exposed coils at the wound surface with close monitoring. Conclusions: Computed tomography angiography is essential for assessing the condition of the remaining embolic coils. In cases with thrombosed parent arteries, a conservative approach, like the transection of exposed coils, can be employed as part of the management strategy. [ABSTRACT FROM AUTHOR]

Objective: Minimally invasive atlantoaxial surgery offers the benefits of reduced trauma and quicker recovery. Previous studies have focused on feasibility and technical aspects, but the lack of comprehensive safety information has limited its availability and widespread use. This study proposes to define the feasibility and range of surgical safety using the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique as a reference point. Methods: Dissection was performed on 10 fresh cadavers to define the anatomical reference point as the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique muscle. The study aimed to analyze the safety range of minimally invasive atlantoaxial fusion surgery by measuring the distance between the anatomical reference point and the transverse foramen of the axis, the distance between the anatomical reference point and the superior border of the posterior arch of the atlas, and the distance between the anatomical reference point and the spinal canal. Measurements were compared using Student's t test. Results: The point where the occipital greater nerve intersects with the inferior border of the inferior cephalic oblique muscle was defined as the anatomical marker for minimally invasive posterior atlantoaxial surgery. The distance between this anatomical marker and the transverse foramen of the axis was measured to be 9.32 ± 2.04 mm. Additionally, the distance to the superior border of the posterior arch of the atlas was found to be 21.29 ± 1.93 mm, and the distance to the spinal canal was measured to be 11.53 ± 2.18 mm. These measurement results can aid surgeons in protecting the vertebral artery and dura mater during minimally invasive posterior atlantoaxial surgery. Conclusions: The intersection of the greater occipital nerve with the inferior border of the inferior cephalic oblique muscle is a safe and reliable anatomical landmark in minimally invasive posterior atlantoaxial surgery. [ABSTRACT FROM AUTHOR]

Background: An experimental study was performed to improve the anterior approach model of intervertebral disc degeneration (IVDD). Objective: The aims of this study were to investigate the anterior approach model of IVDD for the cause of death, phenotypes, and underlying mechanisms of low back pain in mice. Method: In this study, we conducted an anterior puncture procedure on a cohort of 300 C57BL/6J mice that were 8 weeks old. Our investigation focused on exploring the causes of death in the study population (n = 300) and assessing the time‐course changes in various parameters, including radiographical, histological, immunofluorescence, and immunohistochemistry analyses (n = 10). Additionally, we conducted behavioral assessments on a subset of the animals (n = 30). Results: Transverse vertebral artery rupture is a major factor in surgical death. Radiographical analyses showed that the hydration of the nucleus pulposus began to decrease at 2 weeks after puncture and obviously disappeared over 4 weeks. 3D‐CT showed that disc height was significantly decreased at 4 weeks. Osteophyte at the anterior vertebral rims was observed at 2 weeks after the puncture. As the time course increased, histological analyses showed progressive disruption of the destruction of the extracellular matrix and increased secretion of inflammatory cytokines and apoptosis. Behavioral signs of low back pain were increased between the puncture and sham groups at 4 weeks. Conclusion: The improvement of anterior intervertebral disc approach model in mice will be useful to investigate underlying mechanisms and potential therapeutic strategies for behavior and phenotypes. Furthermore, the application of vibrational pre‐treatment can be used to increase the sensitivity of axial back pain in the model, thereby providing researchers with a reliable method for measuring this critical phenotype. [ABSTRACT FROM AUTHOR]

This article discusses the management of a primary extracranial vertebral artery aneurysm (VAA) in a 60-year-old man who presented with recurrent strokes. The patient had an anomalous left vertebral artery with a 25-mm fusiform aneurysm. Due to the tortuosity of the artery, endovascular stent graft management was not possible, and ligation/embolization was not recommended. Instead, the patient underwent a surgical repair involving transposition of the distal vertebral artery onto the left common carotid artery. The patient had a successful recovery and thrombosis of the aneurysm was confirmed in a postoperative ultrasound. Extracranial VAAs are rare and treatment options depend on various factors such as aneurysm location, vessel size, and thrombus burden. Endovascular techniques are generally preferred, but in this case, open surgical repair was chosen due to anatomical factors. [Extracted from the article]

Background and Aim: The present study investigated the correlation between vertebral artery hypoplasia and fetal‐type variations of posterior cerebral arteries with stroke patterns and imaging findings in individuals with posterior circulation ischemic stroke. Methods: In this cross‐sectional study, patients with symptoms of acute ischemic stroke in the posterior circulation system referred to Ghaem Hospital in Mashhad between 2016 and 2022 were investigated. Demographic data, including age, gender, systemic diseases, history of previous stroke or transient ischemic attacks, and clinical manifestations of patients, were recorded using questionnaires and checklists from patient files. The results of imaging studies, including magnetic resonance imaging and computed tomography angiography, were also recorded. The obtained data were analyzed by SPSS statistical software. Results: Among 974 patients suffering from posterior circulation ischemic stroke, 155 patients with an average age of 60.44 ± 13.95 years were included in the study, out of which 97 patients (62.6%) were male. Unilateral vertebral artery hypoplasia on the right, left, and bilateral hypoplasia was present in 67 (43.2%), 35 (22.6%), and 5 (3.2%) patients, respectively. There were complete unilateral fetal origin on the right in 38 (24.5%), complete unilateral on the left in 12 (7.7%), partial unilateral on the right in 12 (7.7%), partial unilateral on the left in 6 (3.9%), complete bilateral in 14 (9%), and partial bilateral in 8 (5.2%) patients. There was no significant relationship between vertebral artery hypoplasia and PCA fetal‐type variants with different ischemia locations and infarct patterns (p > 0.05). Also, there was no significant relationship between the age and gender of patients with ischemia location and infarct pattern (p > 0.05). Conclusion: Despite previous evidence showing a relation between vertebral artery hypoplasia and PCA fetal‐type variants as risk factors for PC stroke, the present study did not establish a significant correlation between these factors and the location of ischemia and infarct patterns. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate if vessel‐wall magnetic resonance imaging (VW‐MRI) could differentiate among primary headaches disorders, such as migraine and cluster headache (CH), and detect the presence of neurogenic inflammation. Background: The pathophysiology of primary headaches disorders is complex and not completely clarified. The activation of nociceptive trigeminal afferents through the release of vasoactive neuropeptides, termed "neurogenic inflammation," has been hypothesized. VW‐MRI can identify vessel wall changes, reflecting the inflammatory remodeling of the vessel walls despite different etiologies. Methods: In this case series, we enrolled seven patients with migraine and eight patients with CH. They underwent a VW‐MRI study before and after the intravenous administration of contrast medium, during and outside a migraine attack or cluster period. Two expert neuroradiologists analyzed the magnetic resonance imaging (MRI) studies to identify the presence of vessel wall enhancement or other vascular abnormalities. Results: Fourteen out of 15 patients had no enhancement. One out of 15, with migraine, showed a focal parietal enhancement in the intracranial portion of a vertebral artery, unmodified during and outside the attack, thus attributable to atherosclerosis. No contrast enhancement attributable to neurogenic inflammation was observed in VW‐MRI, both during and outside the attack/cluster in all patients. Moreover, MRI angiography registered slight diffuse vasoconstriction in one of seven patients with migraine during the attack and in one of eight patients with cluster headache during the cluster period; both patients had taken triptans as symptomatic therapy for pain. Conclusions: These preliminary results suggest that VW‐MRI studies are negative in patients with primary headache disorders even during migraine attacks or cluster periods. The VW‐MRI studies did not detect signs of neurogenic inflammation in the intracranial intradural vessels of patients with migraine or CH. [ABSTRACT FROM AUTHOR]

Objectives: Fabry disease (FD) is a rare X‐linked lysosomal storage disorder with variable phenotypes, including neurological symptoms. These can be influenced by vascular impairment. Extracranial and transcranial vascular sonography is an effective and noninvasive method for measuring arterial structures and blood flow. The study aims to investigate cerebrovascular phenotype characteristics in FD patients compared to controls using neurosonology. Methods: This is a single‐center, cross‐sectional study of 130 subjects—65 patients (38 females), with genetically confirmed FD, and 65 sex‐ and age‐matched controls. Using ultrasonography, we measured structural and hemodynamic parameters, including distal common carotid artery intima‐media thickness, inner vertebral artery diameter, resting blood flow velocity, pulsatility index, and cerebral vasoreactivity (CVR) in the middle cerebral artery. To assess differences between FD and controls and to identify factors influencing investigated outcomes, unadjusted and adjusted regression analyses were performed. Results: In comparison to sex‐ and age‐matched controls, FD patients displayed significantly increased carotid artery intima‐media thickness (observed FD 0.69 ± 0.13 mm versus controls 0.63 ± 0.12 mm; Padj =.0014), vertebral artery diameter (observed FD 3.59 ± 0.35 mm versus controls 3.38 ± 0.33 mm; Padj =.0002), middle cerebral artery pulsatility index (observed FD 0.98 ± 0.19 versus controls 0.87 ± 0.11; Padj <.0001), and significantly decreased CVR (observed FD 1.21 ± 0.49 versus controls 1.35 ± 0.38; Padj =.0409), when adjusted by age, BMI, and sex. Additionally, FD patients had significantly more variable CVR (0.48 ± 0.25 versus 0.21 ± 0.14; Padj <.0001). Conclusions: Our results suggest the presence of multiple vascular abnormalities and changes in hemodynamic parameters of cerebral arteries in patients with FD. [ABSTRACT FROM AUTHOR]

Background and Purpose: The diagnostic value of vertebral artery foraminal segment (V2) ultrasonography remains unclear. This study aimed to estimate the predictive value of V2 Doppler imaging for the detection of vertebrobasilar stenosis or occlusion. Methods: Three hundred sixty‐four vertebral arteries from 182 patients were investigated. Abnormal Doppler spectra were categorized as high‐resistance flow (resistive index ≥0.9), low‐resistance flow (resistive index ≤0.5), increased flow velocity (peak systolic velocity ≥137.5 cm/second), or no flow signal. On MR angiography, stenosis and occlusion were defined as >50% narrowing and absent flow signals, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Sixty of 364 vertebral arteries (16.5%) had V2 Doppler abnormalities, while 89 vertebrobasilar arteries (24.5%) had a stenosis or occlusion. The Doppler abnormalities predicted any stenosis or occlusion in the vertebrobasilar artery with a sensitivity of 56.2% and specificity of 96.4% (PPV, 83.3%; NPV, 87.2%). The hypoplastic vertebral artery (lumen diameter ≤2.7 mm) was more frequently associated with vertebrobasilar stenosis or occlusion, and with abnormal Doppler spectra (mostly high‐resistance flow), even when it was nonstenotic, than the normal‐diameter vertebral artery (p <.001, chi‐square test). Conclusions: : The low sensitivity seems to be due to the high prevalence of non‐V2 lesions not detected on V2 Doppler imaging, suggesting the necessity for a more extensive sonographic examination beyond V2. However, PPV and NPV ≥80% may suggest its usefulness in clinical practice. [ABSTRACT FROM AUTHOR]

Background and Purpose: We aimed to investigate the relationship between the degree and location of vertebrobasilar stenosis and quantitative magnetic resonance angiography (QMRA) distal flow. Methods: We retrospectively reviewed patients who presented with acute ischemic stroke with ≥50% stenosis of the extracranial or intracranial vertebral or basilar arteries, and QMRA performed within 1 year of stroke. Standardized techniques were used to measure stenosis and to dichotomize vertebrobasilar distal flow status. Patients were grouped based on the involved artery and the severity of disease. All p‐values were calculated using chi‐squared analysis and Fisher exact test with statistical significance defined as p <.05. Results: Sixty‐nine patients met study inclusion, consisting of 31 with low distal flow and 38 with normal distal flow. The presence of severe stenosis or occlusion was 100% sensitive, but only 47% predictive and 26% specific of a low distal flow state. Bilateral vertebral disease was only 55% sensitive but was 71% predictive and 82% specific of a low‐flow state and was five times and nearly three times more likely to result in a low‐flow state compared to unilateral vertebral disease (14%) and isolated basilar disease (28%), respectively. Conclusions: Severe stenosis of ≥70% may mark the minimal threshold required to cause hemodynamic insufficiency in the posterior circulation, but nearly half of these patients may remain hemodynamically sufficient. Bilateral vertebral stenosis resulted in a fivefold increase in QMRA low distal flow status compared to unilateral vertebral disease. These results may have implications in the design of future treatment trials of intracranial atherosclerotic disease. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Craniovertebral junction (CVJ) schwannomas are rare tumors, showing direct involvement of the atlanto‐occipital and atlanto‐axial joints. Microsurgical removal is the standard of care to improve symptoms and local control, but stereotactic radiosurgery (SRS) is an option. Both, surgery, and SRS, may show risks of severe complications. A 41‐year‐old male was referred to our department after incidental finding of a right‐sided C1 tumor. A CT angiogram with 3D reconstructions showed the close relationship between the tumor and the right vertebral artery (VA). A post‐contrast enhancement MRI revealed the presence of an extradural mass, sited at the level of the CVJ, mainly at the level of the right articular mass of C1. After multidisciplinary assessment, involving the gamma‐knife and neurosurgical teams, we performed a microsurgical resection of the tumor. Histology confirmed the diagnosis of schwannoma. At 1 year follow‐up the patient is stable, with no recurrence of the tumor. CVJ schwannoma's current standard of care is surgical resection, but longitudinal studies are required, and should promoted promptly since the recent introduction of the new version of GKSRS that allow the treatment of CVJ's lesions. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the percentage of posterior circulation arterial ischaemic stroke (PCAIS) caused by craniovertebral junction (CVJ) anomalies and describe their clinical course. Children admitted to a tertiary care paediatric hospital with PCAIS between July 2017 and December 2020 were assessed retrospectively for disease aetiology. We reviewed the clinical, radiological, and surgical details of children with evidence of CVJ anomalies. Fourteen (24.1%) of 58 children admitted with arterial ischaemic stroke had posterior circulation involvement. The mean age of patients presenting with posterior circulation stroke was 6 years 6 months (range 3 months–15 years), 11 were male. Six of 14 cases with PCAIS were due to CVJ anomaly, their ages ranged from 4 months to 15 years (two age ranges were noted, 4 months–4 years and 11–15 years), four were male. Two children had atlantoaxial dislocation with basilar invagination, two had Bow Hunter syndrome with Chiari malformation type 1 (one with completed stroke), one had Chiari malformation type 1 alone, and one presented with Farber disease with proatlas segmentation anomaly in CVJ. The time lag to stroke and CVJ diagnosis ranged from 2 weeks to 24 months. A dynamic angiogram was required to evaluate biomechanical changes on scans with inconclusive findings on standard stroke imaging. CVJ anomalies are an important treatable cause of paediatric posterior circulation stroke. Cervical spine x‐ray in flexion and extension should be done in all patients with posterior circulation stroke beyond the acute period. In cryptogenic aetiology, provocative angiography with guarded neck rotation should be considered to evaluate possible dynamic vertebral artery compression. What this paper adds: Craniovertebral junction anomalies are an important cause of posterior circulation stroke in children.Evidence of flat occiput, short neck, and short stature in children with posterior circulation stroke should be assessed.Dynamic imaging helps identify dynamic vertebral artery compression. [ABSTRACT FROM AUTHOR]

The article "Cinematic Rendering of Pure Arterial Malformations" in the Annals of Neurology discusses a case of a 39-year-old woman with episodic dizziness due to a pure arterial malformation in the V4 segment of the right vertebral artery. The use of cinematic rendering technology based on CT data allows for photorealistic 3D images that accurately depict the anatomy of the malformation, aiding in treatment planning and avoiding misidentification of the lesion. Pure arterial malformations are rare vascular lesions that typically affect young females and have a benign natural history, often managed conservatively with regular imaging surveillance. [Extracted from the article]

A 50-year-old woman accidentally swallowed a fish bone that punctured her vertebral artery, leading to successful surgical repair involving multiple medical specialties. The fish bone was identified through urgent computed tomography, and after emergency exploratory surgery, a vertebral artery stent graft was placed to stop the bleeding. This case highlights the potential complications of swallowing foreign objects and the successful surgical intervention in this unique situation, with the patient recovering well at the 6-month follow-up. [Extracted from the article]

Objective: To investigate the clinical effect of butylphthalide combined with urinary kallidinogenase in the treatment of chronic cerebral circulatory insufficiency (CCCI). Methods: A total of 102 CCCI patients admitted to our hospital from October 2020 to December 2021 were retrospectively enrolled in this study. According to the different therapeutic strategy, the patients were divided into combined group (treated with butylphthalide combined with urinary kallidinogenase, n = 51) and butylphthalide group (treated with butylphthalide, n = 51). Blood flow velocity and cerebral blood flow perfusion before and after treatment between the two groups were compared. The clinical efficacy and adverse events of the two groups were analyzed. Results: After treatment, the effective rate of the combined group was significantly higher than the butylphthalide group (p =.015). Before treatment, the blood flow velocity of middle cerebral artery (MCA), vertebral artery (VA), basilar artery (BA) were comparable (p >.05, respectively), while after treatment, the blood flow velocity of MCA, VA, and BA in combined group were faster than those in butylphthalide group (p <.001, respectively). Before treatment, the relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transmit time (rMTT) of the two groups were comparable (p >.05, respectively). After treatment, rCBF and rCBV in combined group were higher than those in butylphthalide group (p <.001, respectively), and rMTT in combined group was lower than that in butylphthalide group (p =.001). The rate of adverse events in the two groups were comparable (p =.558). Conclusion: Butylphthalide combined with urinary kallidinogenase can improve the clinical symptoms of CCCI patients, and the effect is promising, which is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Pan-sarcoma genomic analysis of KMT2A rearrangements reveals distinct subtypes defined by YAP1-KMT2A-YAP1 and VIM-KMT2A fusions. Based on the tumour immunophenotype, the differential diagnosis included a malignant round cell sarcoma, not otherwise specified, malignant peripheral nerve sheath tumour and fusion or ITD-related round cell sarcomas, including sarcomas with BCOR-related genetic alterations, CIC-rearranged sarcoma, synovial sarcoma and NTRK-rearranged sarcoma among others. [Extracted from the article]

A 69‐year‐old man suddenly developed bilateral hearing impairment and dizziness. Magnetic resonance imaging showed multiple infarctions in the area of the bilateral posterior circulation, and magnetic resonance angiography showed a completely occluded right vertebral artery (VA) and severe stenosis of the left VA. Pearl and string sign was detected in the left VA by cerebral angiography, leading to the diagnosis of arterial dissection. The infarctions in the anterior inferior cerebellar artery area were considered a result of artery‐to‐artery embolism. He regained his hearing gradually and was discharged in 2 weeks. Acute ischemic stroke with bilateral hearing loss is generally accompanied by proximal severe vascular legions, with poor outcome. Prognosis may depend on the underlying vascular pathology. [ABSTRACT FROM AUTHOR]

Postural change intermittently between upright and head down in giraffes standing at a height of 4.5 meters is of physiological significance. The length of a giraffe's neck denotes the flow of blood against the force of gravity, to supply the brain over a 2 m distance. The force of gravity also affects the flow of blood toward the brain, with a posture change from erect to ground level. How do these changes in stance not result in fainting when the head is raised and brain damage when the head is lowered? Giraffe has an advanced interconnection of the common carotid artery and the vertebral artery. The connection is located at the midpoint of the atlas, as indicated by means of computerized tomography and dissection. Duplex ultrasound with Doppler waveform examination showed the unidirectional movement of blood with movement from the vertebral artery into the common carotid artery when the head is erect. The direction of flow allows the provision of blood to the maxillary artery that feeds the rostral epidural rete that supplies to the brain. The flow direction in the carotid-vertebral connection changes when blood moves in the direction of the head along with the force of gravity, when the head is lowered. The rerouting of blood to move from the common carotid into the vertebral artery prevents brain damage. We have confirmed, by utilizing a CT scan, Doppler sonar, and dissection of latex-filled arteries, the existence and blood flow direction within the anastomotic artery associated with variation in posture in the giraffe. [ABSTRACT FROM AUTHOR]

The prevalence and complexity of cardiovascular disease (CVD) in the West of Scotland are high with the aortic arch and abdominal aorta, particularly at increased risk of cardiovascular pathology. Stent deployment can be key in preventing further cardiovascular events, however, current stent design does not account for complex advanced CVD in these areas. This cadaveric study aimed to provide anatomical measurements requested by manufacturers to improve stent design and deployment in this target population. Nine cadavers (six females and three males; age range = 82.7 ± 10.4 years) from the West of Scotland were dissected to expose the aortic arch and abdominal aorta. Digital callipers and protractors were used to collect data on vessel diameters (including taper), branch spacing, angles and presence of collaterals. CVD was present in all cadavers and ranged from mild plaque presence to aortic dissections. One possessed a bovine aortic arch variation. Supra‐aortic vessels were approximately equally spaced, but the left common carotid had the most acute branching angle. Angulation of the arch from the coronal plane positively correlated with a deviation of the left subclavian artery (LSA) from the sternal midline (Spearman's coefficient r = 0.82, p = 0.01) which may impact surgical access. The origin of the vertebral artery on the LSA was also highly variable. The diameter of the descending aorta decreased along its length from the aortic hiatus to superior mesenteric by 21 ± 10% indicating a high degree of taper. The artery of Adamkiewicz was present in 33% and additional renal collaterals were present in 22%. 66% had tortuous vessels in the abdominal region. These results highlight the need for more data to aid the refinement of stent‐graft design and deployment methods to ensure successful surgical intervention in this population. [ABSTRACT FROM AUTHOR]

Background and Aim of the Study: Interrupted aortic arch (IAA) is a rare and fatal malformation. Most patients with IAA are diagnosed in early childhood because of the severity of their symptoms. IAA is classified into three morphologic types (A, B, or C), depending on the site of the interruption. In our case, this patient did not have a common brachiocephalic trunk, left carotid artery, or left subclavian artery, IAA classification of this case cannot be judged based on the existing interruption method. Methods: We present a 6‐year‐old Chinese boy with a history of neck masses since birth, and an echocardiogram from a local county hospital revealing an IAA without any cardiac anomalies, was referred to our hospital. Results: The patient was feeling good and was nearly asymptomatic. Computed tomography angiography was performed, which indicated an absent aortic arch, likely due to disruption during development, and aortic discontinuity. The ascending aorta gave rise to both carotid arteries, and the descending aorta was supplied by large subclavian arteries. The right vertebral artery was supplied by right large collateral vessels that connected the right carotid artery. The left side was similar in structure to the right side. The descending aorta was supplied by large subclavian arteries. The subclavian arteries and carotid arteries were connected by large collateral vessels. Due to the large collateral vessels, the child's lower body had sufficient blood supplied, so that the typical differential cyanosis did not occur, and the child without symptomatic can survive to now. Conclusions: This patient did not have a common brachiocephalic trunk, left carotid artery, or left subclavian artery. Maybe, this patient belonged to a new type of IAA. [ABSTRACT FROM AUTHOR]

Recently, several centers have performed total arch replacement using the fenestrated frozen elephant trunk technique for acute Stanford type‐A aortic dissection. However, the long‐term results and need for additional treatment following this procedure are unclear. We report a case of a 54‐year‐old man who underwent endovascular therapy for endoleaks after total arch replacement using the fenestrated frozen elephant trunk technique for acute type‐A aortic dissection with an isolated left vertebral artery. After the surgery, the endoleak was resolved, and the patient was asymptomatic with no neurological deficits. This strategy might be effective in similar cases. When endoleak occur after TAR using the fenestrated frozen elephant trunk technique in patients with rare anatomical subtypes, collaboration with other experts facilitates additional treatment. [ABSTRACT FROM AUTHOR]

Background: Early surrogates for functional outcome in anterior circulation stroke have been described with the National Institute of Health Stroke Scale (NIHSS) at 24 h being reported as the most accurate metric. We compare discriminatory power of established definitions of early neurological improvement (ENI) and NIHSS scores at admission and 24 h to predict functional outcome at 90 days after thrombectomy in posterior circulation stroke (PCS). Methods: All patients enrolled in the German Stroke Registry (June 2015–December 2019) with PCS and at least vertebral or basilar artery occlusions were included. NIHSS admission, 24 h and ENI definitions (improvement of 8/10 NIHSS points or 0/1 NIHSS points at 24 h) were compared for predicting functional outcome at 90 days. Favourable and good outcome were defined as modified Rankin Scale (mRS) 0–2 and 0–3. Multivariable logistic regression analysis was conducted to identify factors impairing predictive power. Results: Three hundred and eighty‐seven patients were included. NIHSS 24 h had the highest discriminative power with receiver operator characteristics area under the curve of 0.87 (95% confidence interval: 0.83; 0.90) for good and 0.89 (0.85; 0.92) for favourable outcome; optimal cut‐off values were ≤9 and ≤5. Higher age (odds ratio = 1.10 [1.05; 1.16]), adverse events during treatment (9.46 [1.52; 72.5]) and until discharge (18.34 [2.33; 172]) and high NIHSS scores at 24 h (1.29 [1.10; 1.53]) were independent predictors for turning the outcome prognosis from good (mRS ≤3) to poor (mRS ≥4). Conclusions: NIHSS 24 h ≤9 points serves best as surrogate for good functional outcome after thrombectomy in PCS. Advanced age, severe neurological symptoms at admission and adverse events decrease its predictive value. [ABSTRACT FROM AUTHOR]

Vertebral artery dissection is a common cause of stroke in young adults without predisposing risk factors for cerebrovascular disease. We describe the case of a 28-year-old patient who presented with an ischemic stroke secondary to a stab wound to the neck that affected the vertebral artery. A physical examination revealed neurological deterioration (Glasgow 8/15), a sutured neck wound, no palpable hematoma, no thrills, and no active bleeding. A computed tomography angiography revealed a left vertebral artery arteriovenous fistula with a component of a pseudoaneurysm, for which a neurointerventional consultation was carried out. Due to neurological compromise, the airway was secured, and because the case involved a posterior fossa infarction with compression of the fourth ventricle and obstructive secondary hydrocephalus, an external ventricular shunt was inserted by neurosurgery. A fistula occlusion was performed with five Axium coils and a vial of Squid 12; the vertebral artery was catheterized, and a craniotomy was performed to manage hydrocephalus with a 12-mm H2O collecting system. The patient was discharged on the tenth day after admission with sequelae of left hemiparesis (predominantly brachial) and no other deficits. There was no hemorrhagic transformation on the control computed tomography scans and no further complications. [ABSTRACT FROM AUTHOR]

Background: Vertebral artery injury (VAI) during cervical spine surgery is rare. Anterior controllable ante‐displacement and fusion (ACAF) surgery is a novel technique for treating degenerative cervical spine disorders, especially ossification of the posterior longitudinal ligament. To date, there have been no reports of VAI during cervical ACAF surgery. Here, we report a rare case of perioperative complication of VAI during ACAF surgery. The available English literature that provides treatment instructions were reviewed. Case Presentation: A patient diagnosed with mixed ossification of the posterior longitudinal ligament (OPLL) underwent ACAF surgery from C2–C6. Two level transverse foramina were ruptured, and severe bleeding was encountered during ACAF osteotomy. Hemostatic tamponade was performed using bone waxes. The patient had delayed hemorrhage on postoperative day 6. Emergence angiography revealed two vertebral artery pseudoaneurysms in the ruptured transverse foramina. A balloon‐expandable covered stent was deployed to treat the pseudoaneurysm. The patient recovered without complications. Conclusion: ACAF surgery is a good choice for multiple‐level OPLL disease, but special attention should be paid to VAI in the perioperative period. Intraoperative tamponade with bone wax and postoperative digital subtraction angiography (DSA) are effective in preventing disaster‐related hemorrhage. [ABSTRACT FROM AUTHOR]

Ischemic stroke (IS) is a general term for necrosis of brain tissue caused by stenosis, occlusion of arteries supplying blood to the brain (carotid artery and vertebral artery), and insufficient blood supply to the brain. Cerebral ischemia is the main kind of IS causing cell damage. However, the underlying mechanism still needs to be clarified further. In this study, it was demonstrated that FFAR1 was a hub gene in IS. The expression of FFAR1 was increased in PC12 cells with OGD/R treatment. FFAR1 deficiency inhibited cell viability and induced cell apoptosis, which was reversed by FFAR1 overexpression. Moreover, candesartan, as a compound targeting FFAR1, facilitated cell viability and reduced cell apoptosis. The expression of ITGA4 was also high in OGD/R-PC12 cells as FFAR1. Furthermore, FFAR1 deficiency retarded the increasing of cell viability and inhibition of cell apoptosis by downregulation of Bax and Cleaved Caspase-3 in OGD/R-PC12 cells with candesartan treatment. In conclusion, candesartan may regulate neuronal apoptosis through FFAR1/ITGA4 axis. [ABSTRACT FROM AUTHOR]

Background: Little is known about the distribution of the intracranial arteries that are responsible for noncardiogenic posterior circulation stroke (PCS) in the Chinese population. Furthermore, few studies have compared the imaging manifestations and outcomes across PCS due to the disease of different intracranial arteries. Therefore, our aim was to demonstrate the distribution of the intracranial arteries that were responsible for noncardiogenic PCS and to compare the imaging manifestations and outcome across PCS due to the disease of different intracranial arteries. Methods: We prospectively enrolled 690 patients from 22 Chinese centers with noncardiogenic PCS due to intracranial artery disease. Intracranial artery disease was classified as intracranial vertebral artery disease (IVAD) and intracranial nonvertebral artery disease (INVAD). Clinical‐radiologic patterns and outcomes were compared between IVAD and INVAD. Results: INVAD was more frequent than IVAD. Compared to the INVAD group, the IVAD group more frequently had hypertension, coronary heart disease, multiple infarcts, border zone infarcts, territorial infarcts, small cortical infarcts, multilevel infarcts, multisector infarcts, and more often had severe stenosis of the responsible artery, more often presented with decreased alertness, gaze palsy, bilateral limb weakness, ataxia, dysphagia, diplopia, vertigo, and headache. In addition, the IVAD group had a higher National Institutes of Health stroke scale score and modified Rankin Scale score at discharge and more deaths and recurrent ischemic cerebrovascular disease within 1 year of onset. Multivariable Cox regression identified IVAD as an independent predictor of recurrent ischemic cerebrovascular disease. Conclusions: PCS due to INVAD was more common in the Chinese population. However, PCS due to IVAD had more serious clinical‐radiologic patterns and worse outcomes. [ABSTRACT FROM AUTHOR]

The presence of transverse foramina in the axes of Japanese serows, a special national natural treasure in Japan, has been reported to be unstable, but other variations are unknown. In this study, we analysed the shape, cross‐sectional area, length, and volume of the transverse foramen in the axes of 19 specimens using gross anatomy and computed tomography (CT) scan. There were four types in the transverse foramen: type 1, having the transverse foramina; type 2, having two cranial openings; type 3, sifting a caudal opening to the ventral side of the transverse process; and type 4, having no transverse foramina. Although the transverse foramina showed different types on the left and right sides in several specimens, there were no statistically significant differences in the length and volume. This variation may be related to running patterns of the vertebral artery penetrating the transverse foramina. Two goats without the transverse foramina were examined to infer a running pattern of the vertebral artery instead of Japanese serows. The vertebral artery in the goats branched in two directions (spinal and muscle), between the axis and the third cervical vertebra. This passage of the goat vertebral artery might be presumed in type 4 of Japanese serows. This study reveals the instability of the transverse foramina in the axes of Japanese serows and provides new data to compare the axes of other ruminants. [ABSTRACT FROM AUTHOR]

Introduction: Left subclavian artery (LSA) bypass surgery is mainly carried out for patients with severe left subclavian occlusion. This article aimed to evaluate the hemodynamic effects of different surgical bypass modes on LSA revascularization. Methods: Three‐dimensional models of the aorta were reconstructed from CTA images of a patient with LSA occlusion, a patient with type B aortic dissection with LSA coverage during thoracic endovascular aortic repair, and a healthy 74‐year‐old man, resulting in six modes for each person: healthy LSA mode, LSA occlusion mode and four bypass modes. Hemodynamic parameters, including flow field, flow distribution, pressure gradient, and wall shear stress, were calculated using computational fluid dynamics. Results: After LSA bypass surgery, distal LSA blood flow resulting from left common carotid artery (LCCA) to distal LSA bypass was 100% of that in the healthy mode, while the other modes yielded flows at least 91%. Moreover, reversed flow only completely disappeared with LCCA to distal LSA bypass, whereas reverse flow was observed in the other three modes in early systole. Conclusion: Left common carotid artery to distal LSA bypass can effectively reduce reverse blood flow in the left vertebral artery, and it is a feasible, effective, and safe option for LSA revascularization in patients with left subclavian occlusion. [ABSTRACT FROM AUTHOR]

Headache is one of the most common symptoms encountered during the postpartum period. The cause may be unknown, or the following illnesses are possible: cervical artery dissection (CAD), reversible posterior cerebral encephalopathy syndrome (PRES), and reversible cerebral vasoconstrictor syndrome (RCVS). It is suggested that they are interrelated and share a similar mechanism such as small vessel endothelial dysfunction, deficiencies in self‐regulation, and decreased sympathetic innervation of the posterior circulation. However, there are few reports of neuroradiological findings. We experienced a rare case of multiple postpartum vascular disease occurring at the same time. A 38‐year‐old woman suddenly developed thunderclap headache after giving birth. She was clear and had no neuropathy. Computed tomography revealed subarachnoid hemorrhage, including the cortical surface of the frontal lobe. Magnetic resonance image fluid‐attenuated inversion recovery revealed high‐intensity area in the bilateral basal ganglia and right occipital cortex. Angiography showed "string sausage" and extracranial left vertebral artery stenosis, but no aneurysm. Based on the clinical course and neuroradiological findings, we diagnosed her as postpartum vascular disease including CAD, PRES, RCVS, and cortical subarachnoid hemorrhage (SAH). Three‐dimensional black blood T1‐weighted images using a motion‐sensitized driven equilibrium three‐dimensional turbo spin echo (MSDE) sequencing method revealed an intramural hematoma consistent with the extracranial vertebral artery. After 3 months, MSDE lost its abnormal signal. Our case was rare in that multiple phenomena of postpartum vascular disease occurred at the same time. In particular, we could reveal that this speculation was reversible in the MRI MSDE sequencing. [ABSTRACT FROM AUTHOR]

Bow Hunter's syndrome is a rare condition in which vertebrobasilar circulatory insufficiency develops because of neck rotation. We report a patient with Bow Hunter's syndrome diagnosed by Doppler sonography. This report demonstrates the important role of Doppler sonography in diagnosis of Bow Hunter's syndrome. [ABSTRACT FROM AUTHOR]

Bilateral medial medullary infarction (MMI) is a rare form of ischemic stroke, mainly caused by vertebral artery atherosclerosis or small penetrating artery disease. We report a case of bilateral MMI due to varicella‐zoster virus (VZV) vasculopathy. An 81‐year‐old man presented with altered consciousness and right hemiplegia during disseminated herpes zoster. Polymerase chain reaction analysis of his cerebrospinal fluid detected positive VZV‐DNA, and magnetic resonance imaging revealed ischemic infarction localized to the ventral part of the bilateral medial medulla and enhancement of the left vertebral artery. After initiating intravenous acyclovir administration, his consciousness, skin rashes, and general condition improved gradually, whereas pyramidal symptoms deteriorated into quadriplegia. This case demonstrates that VZV vasculopathy may cause bilateral MMI. [ABSTRACT FROM AUTHOR]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, discusses the carotid-subclavian artery index (CSAi) in the fetal aortic arch between 19 and 22 weeks of gestation. The study included 262 low-risk singleton pregnancies, and the aortic arch was investigated in a sagittal view to determine its branching pattern. The CSAi was measured by two operators, and the results showed that 26% of the cases had variants of the aortic arch. Additionally, there was a significant difference in the CSAi between classical branching and brachiobicephalic trunks. The findings suggest that these factors should be considered in cases of suspected coarction of the aorta. [Extracted from the article]

Understanding how the brain is provided with glucose and oxygen is of particular interest in human evolutionary studies. In addition to the internal carotid arteries, vertebral arteries contribute significantly to the cerebral and cerebellar blood flow. The size of the transverse foramina has been suggested to represent a reliable proxy for assessing the size of the vertebral arteries in fossil specimens. To test this assumption, here, we statistically explore spatial relationships between the transverse foramina and the vertebral arteries in extant humans. Contrast computed tomography (CT) scans of the cervical regions of 16 living humans were collected. Cross‐sectional areas of the right and left transverse foramina and the corresponding vertebral arteries were measured on each cervical vertebra from C1 to C6 within the same individuals. The cross‐sectional areas of the foramina and corresponding arteries range between 13.40 and 71.25 mm2 and between 4.53 and 29.40 mm2, respectively. The two variables are significantly correlated except in C1. Using regression analyses, we generate equations that can be subsequently used to estimate the size of the vertebral arteries in fossil specimens. By providing additional evidence of intra‐ and inter‐individual size variation of the arteries and corresponding foramina in extant humans, our study introduces an essential database for a better understanding of the evolutionary story of soft tissues in the fossil record. [ABSTRACT FROM AUTHOR]

Background: Penetrating spinal cord injury (PSCI) with retained foreign bodies (RFB) is rarely observed in clinics and may result in a complete or incomplete neurological deficit. This study was performed to appraise the treatment effect of laminectomy for PSCI with RFB. Case Presentation: This study presented three patients referred to a tertiary hospital between August 2011 and October 2018 due to PSCI with RFB and receiving laminectomy. The first patient was a 25‐year‐old female with a butcher's knife piercing the T9 lamina and T10 vertebral body obliquely; the second was a 49‐year‐old male who suffered a perforating wound of the cervical spinal canal and injury of vertebral artery from foreign glass, while the third was a 60‐year‐old male with a wooden stick penetrating stomach and terminating in the L1 lamina. The first and second patients immediately underwent laminectomy for debridement and removal of RFB, while the third received two‐staged operations to remove the retained stick thoroughly. Unfortunately cases 1 and 3 eventually resulted in total paralysis and case 2 revealed no improvement in myodynamia. Then, Medline/PubMed, Embase and the Cochrane Library were systematically searched, and 23 articles involving 25 additional cases with this kind of injury were included for analysis. Conclusions: The optimal treatment strategy for penetrating spinal cord injury with retained foreign bodies remains challenging and should be assessed case‐by‐case. If possible, surgical removal of foreign bodies by laminectomy is preferred immediately to prevent delayed presentation and persistent contamination. Meanwhile, a multidisciplinary team is needed to address concomitant injuries. [ABSTRACT FROM AUTHOR]

Background: Ponticulus posticus (PP) occurs frequently and may cause symptom series, including vertebrobasilar insufficiency, migraine, hearing loss, and Barré‐Liéou syndrome. However, few studies to date have described surgical treatment of PP. We report a rare case of a patient who suffered from torticollis, facial asymmetry, localized pain, and Barré‐Liéou syndrome in connection with PP. We also review the pertinent literature, focusing on surgical treatment for symptoms due to PP. Case presentation: A 23‐year‐old male presented with the chief complaint of continuous significant dizziness to the point of losing consciousness while rotating his head to the right. Plain radiographs and computed tomography (CT) scans of the cervical spine showed a С1 anomaly with the formation of complete PP on the left (dominant) side, with acute‐angled, С‐shaped kinking of the vertebral artery. Resection of PP via the posterior midline was performed successfully. The patient had satisfactory postoperative relief from localized pain and Barré‐Liéou syndrome, but there were no obvious changes in the torticollis and facial asymmetry observed during the 3‐month follow‐up period. Conclusions: This case is a rare presentation of torticollis, facial asymmetry, localized pain, and Barré‐Liéou syndrome in connection with one‐sided complete PP. This tetrad indicates that PP may affect the patient earlier than expected. In such situations, early diagnosis and timely surgical treatment may significantly improve patients' quality of life and avoid the development of torticollis and face asymmetry. [ABSTRACT FROM AUTHOR]

The vertebral arteries, as the first branches from the subclavian arteries, normally enter into the transverse foramen of the sixth cervical vertebra in dogs. This case report presents the non‐standard course of the left vertebral artery and unilateral asymmetry of the sixth cervical vertebra in a 14‐year‐old female mixed breed dog. The anomaly was an incidental finding during the preparation of a corrosion cast prepared for educational and scientific purposes. The left sixth cervical vertebra transverse foramen and the ventral lamina were not developed. The left vertebral artery originated normally from the left subclavian artery, but atypically entered into the transverse foramen of the fifth cervical vertebra. On the right side, the anatomical structures of the sixth cervical vertebra and the course of the right vertebral artery were normally developed. To our knowledge, this is the first case of such an anomaly described in a dog. [ABSTRACT FROM AUTHOR]

In this study, a case of bilateral common carotid artery occlusion and aneurysm in the V4 segment of the right vertebral artery with constriction of the left vertebral artery is presented. By improving digital subtraction angiography, an elderly female patient with subarachnoid haemorrhage (SAH) was diagnosed with a V4 segment of right vertebral artery aneurysm, a microaneurysm at the beginning of basilar aneurysms, bilateral common carotid artery occlusion, and narrowing vessel of left vertebral artery (DSA). Through the compensation of the basilar artery, the bilateral vertebral arteries provide intracranial and extracranial blood. Because the vertebral artery is narrowed, the right vertebral artery has priority in intracranial and extracranial blood delivery. Many members of the patient's immediate family have vasculitis, which has yet to be proven by appropriate laboratory testing but is thought to be the major cause of big artery occlusion. After cerebral angiography, the major source of this subarachnoid haemorrhage was determined to be a V4 segment of right vertebral artery aneurysm. Endovascular stent-assisted coil embolization was used to treat a V4 section of the right vertebral artery aneurysm. Because the basilar aneurysm was distal to the artery, interventional embolization was difficult to do, and it was not the major cause of the subarachnoid haemorrhage, the patient was advised to have follow-up surveillance, and she recovered well following the procedure. The combination of endovascular intervention of bilateral common carotid artery blockage and V4 segment of right vertebral artery aneurysm yielded excellent clinical outcomes in this instance. Endovascular treatment of a bilateral common carotid artery blockage paired with a V4 segment of a right vertebral artery aneurysm yielded excellent clinical outcomes in this patient, although long-term follow-up is necessary. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study is to investigate the efficacy of moxibustion combined with an ear acupoint pressing bean in the treatment of patients with phlegm stasis syndrome vertigo. Methods. 60 patients with vertigo identified as phlegm stasis syndrome who were hospitalized in our department from May 2020 to May 2021 were selected and divided into a control group and a treatment group of 30 cases each according to the random number method. The control group was treated with conventional treatment and care, and the treatment group was treated with moxibustion combined with ear acupressing beans on top of the conventional group. The treatment effects, the dizziness disorder inventory (DHI), Pittsburgh sleep quality index (PSQI), Hamilton anxiety score (HAMA), TCM symptom score, and blood flow parameters (left vertebral artery flow velocity (LVA), right vertebral artery flow velocity (RVA), and basilar artery flow velocity (BA)) of the two groups were compared with each other during and after the treatment. Results. After implementation, the treatment efficiency of the treatment group was higher than that of the control group, and the treatment group had lower PSQI, HAMA, and DHI scores as well as TCM symptom scores such as vertigo, head heavy as a wrap, chest tightness, and nausea and vomiting than the control group (P < 0.05). In addition, LVA, RVA, and BA were all higher in the treatment group than in the control group after treatment (P < 0.05). Conclusion. Moxibustion combined with ear acupoint pressing bean treatment can clearly improve patients' sleep quality, psychological state, relieve patients' various symptoms caused by vertigo, improve blood flow parameters, and have better efficacy in the treatment of phlegm stasis syndrome vertigo. [ABSTRACT FROM AUTHOR]

The anomalous origin of a hypoplastic Left Vertebral Artery (LVA) from the aortic arch is a rare anatomic variant. This study discusses the case of a patient with a C1 lateral mass tumor that surrounded a dominant Right Vertebral Artery (RVA) according to preoperative computed tomography angiography, with a hypoplastic LVA originating from the aortic arch. Surgery was performed, and the patient recovered uneventfully. To date, no study has reported the simultaneous association of two variations (origin and diameter) in the LVA. A deep understanding of abnormalities in the diameter and origin of LVA is a must for neurosurgeons as well as for thoracic and vascular surgeons to conduct surgical procedures. [ABSTRACT FROM AUTHOR]

In young adults, spontaneous craniocervical arterial dissections (sCAD), which involve the major arteries of the head and neck, are associated with an increased risk of stroke. sCAD occurs in the absence of major trauma as seen in traumatic craniocervical artery dissection. It may affect unilateral or bilateral carotid or vertebral arteries. Cases of spontaneous bilateral carotid and vertebral artery dissections occurring simultaneously are extremely rare. We present a case of a 49-year-old female with no history of arteriopathy who presented with aphasia and right upper extremity weakness and was found to have dissections in bilateral extracranial and intracranial carotid arteries, as well as the bilateral vertebral arteries. She had symptomatic improvement with antithrombotic therapy and aggressive outpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Optimal carotid duplex velocity criteria for defining the severity of carotid in-stent restenosis. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study. In addition, scanning in and through an area of stenosis or suspected stenosis must be adequate to determine the maximal peak systolic velocity and end-diastolic velocity associated with the stenosis and to document disturbances in the waveform distal to the stenosis. The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of clinical practice parameters, and accreditation of practices performing ultrasound examinations. [Extracted from the article]

Introduction. The association between arterial tortuosity and acute ischemic stroke (AIS) has been reported, but showing inconsistent results. We hypothesized that tortuosity of extra- and intracranial large arteries might be higher in AIS patients. Furthermore, we explored the correlation between artery tortuosity and white matter hyperintensity (WMH) severity in AIS patients. Methods. 166 AIS patients identified as large artery atherosclerosis, and 83 control subjects were enrolled. All subjects received three-dimensional computed tomography angiography (CTA). Arterial tortuosity was evaluated using the tortuosity index. WMHs were evaluated using magnetic resonance imaging in all AIS patients. Results. AIS patients showed significantly increased arterial tortuosity index relative to controls, including left carotid artery (CA) (p = 0.001), right CA (p < 0.001), left common carotid artery (CCA) (p < 0.001), right CCA (p < 0.001), left internal carotid artery (p = 0.001), right internal carotid artery (p = 0.01), left extracranial internal carotid artery (EICA) (p < 0.001), right EICA (p = 0.01), and vertebral artery dominance (VAD) (p = 0.001). The tortuosity of all above arteries was associated with the presence of AIS. AIS patients with moderate or severe WMHs had a higher tortuosity index in left CA (p = 0.005), left CCA (p = 0.003), left EICA (p = 0.07), and VAD (p = 0.001). In addition, the tortuosity of left EICA and VAD was associated with WMH severity in AIS patients. Conclusions. Increased extra- and intracranial large arteries tortuosity is associated with AIS. The tortuosity of left carotid artery system and vertebral artery may be the independent risk factors for WMH severity in AIS patients. Clinical Trial Registration. This trial is registered with NCT03122002 (http://www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]