open access

Vol 78, No 4 (2019)
ORIGINAL ARTICLES
Published online: 2019-04-03
Submitted: 2018-12-31
Accepted: 2019-03-06
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The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

X. Li, L. Guan, Prince L.M. Zilundu, J. Chen, Z. Chen, M. Ma, H. Zhuang, Z. Zhuang, Y. Qiu, F. Ye, X. Wu, H. Sang, Y. Ye, Y. Han, H. Yao, H. Li, G. Zhong, H. Wu, Z. Jiang, G. Chu, D. Xu, L. Zhou
DOI: 10.5603/FM.a2019.0039
·
Pubmed: 30949997
·
Folia Morphol 2019;78(4):710-719.

open access

Vol 78, No 4 (2019)
ORIGINAL ARTICLES
Published online: 2019-04-03
Submitted: 2018-12-31
Accepted: 2019-03-06

Abstract

Background: The aim of the study was to probe the morphological features of the proximal segment (V1) of vertebral artery (VA) in a sample of Chinese cadavers. Materials and methods: The origin, course and outer diameter at origin of the pre-vertebral part of the VAs were evaluated in 119 adult cadavers. Results: It was found that 94.12% of the VAs originated from the subclavian arteries, bilaterally. The variant origins were present in 5.88% of the cadavers and all originated directly from the arch of the aorta. All the variations were observed on the left side of male cadavers. The average outer diameters at origin of the normal and variation groups were 4.35 ± 1.00 mm and 4.82 ± ± 1.42 mm, respectively, p = 0.035. In the normal group, but not in the variation group, the average diameter in the males was significantly larger than that in the females (4.50 ± 0.99 mm, 3.92 ± 0.92 mm, respectively, p = 0.000). In addition, only 5 cadavers in the normal group had hypoplastic VAs (4.20%, 4 males, 3 right-sided). Vertebral artery dominance (VAD) was present in 91 (69 males) out of 112 cadavers and more common on the left (n = 48). In addition, 3 cadavers satisfied conditions for coexistence of VAD and vertebral artery hypoplasia. All 7 cadavers in the variation group exhibited VAD, which was more common on the right side (n = 5). Conclusions: The morphologic variations and frequencies described above have implications for the early prevention, abnormal anatomy detection, accurate diagnosis, safe surgery and endovascular treatment of cardiovascular and neurological disease.

Abstract

Background: The aim of the study was to probe the morphological features of the proximal segment (V1) of vertebral artery (VA) in a sample of Chinese cadavers. Materials and methods: The origin, course and outer diameter at origin of the pre-vertebral part of the VAs were evaluated in 119 adult cadavers. Results: It was found that 94.12% of the VAs originated from the subclavian arteries, bilaterally. The variant origins were present in 5.88% of the cadavers and all originated directly from the arch of the aorta. All the variations were observed on the left side of male cadavers. The average outer diameters at origin of the normal and variation groups were 4.35 ± 1.00 mm and 4.82 ± ± 1.42 mm, respectively, p = 0.035. In the normal group, but not in the variation group, the average diameter in the males was significantly larger than that in the females (4.50 ± 0.99 mm, 3.92 ± 0.92 mm, respectively, p = 0.000). In addition, only 5 cadavers in the normal group had hypoplastic VAs (4.20%, 4 males, 3 right-sided). Vertebral artery dominance (VAD) was present in 91 (69 males) out of 112 cadavers and more common on the left (n = 48). In addition, 3 cadavers satisfied conditions for coexistence of VAD and vertebral artery hypoplasia. All 7 cadavers in the variation group exhibited VAD, which was more common on the right side (n = 5). Conclusions: The morphologic variations and frequencies described above have implications for the early prevention, abnormal anatomy detection, accurate diagnosis, safe surgery and endovascular treatment of cardiovascular and neurological disease.

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Keywords

anatomy, vertebral artery — hypoplasia, dominance

About this article
Title

The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

Journal

Folia Morphologica

Issue

Vol 78, No 4 (2019)

Pages

710-719

Published online

2019-04-03

DOI

10.5603/FM.a2019.0039

Pubmed

30949997

Bibliographic record

Folia Morphol 2019;78(4):710-719.

Keywords

anatomy
vertebral artery — hypoplasia
dominance

Authors

X. Li
L. Guan
Prince L.M. Zilundu
J. Chen
Z. Chen
M. Ma
H. Zhuang
Z. Zhuang
Y. Qiu
F. Ye
X. Wu
H. Sang
Y. Ye
Y. Han
H. Yao
H. Li
G. Zhong
H. Wu
Z. Jiang
G. Chu
D. Xu
L. Zhou

References (51)
  1. Akar ZC, Dujovny M, Slavin KV, et al. Microsurgical anatomy of the intracranial part of the vertebral artery. Neurol Res. 1994; 16(3): 171–180.
  2. Cagnie B, Petrovic M, Voet D, et al. Vertebral artery dominance and hand preference: is there a correlation? Man Ther. 2006; 11(2): 153–156.
  3. Caplan LR, Wityk RJ, Glass TA, et al. New England Medical Center Posterior Circulation registry. Ann Neurol. 2004; 56(3): 389–398.
  4. Chen YY, Chao AC, Hsu HY, et al. Vertebral artery hypoplasia is associated with a decrease in net vertebral flow volume. Ultrasound Med Biol. 2010; 36(1): 38–43.
  5. Cosar M, Yaman M, Eser O, et al. Basilar artery angulation and vertigo due to the hemodynamic effect of dominant vertebral artery. Med Hypotheses. 2008; 70(5): 941–943.
  6. Delcker A, Diener HC. [Various ultrasound methods for studying the vertebral artery--a comparative evaluation]. Ultraschall Med. 1992; 13(5): 213–220.
  7. Ergun O, Gunes Tatar I, Birgi E, et al. Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients. Folia Morphol. 2016; 75(1): 33–37.
  8. Eskander MS, Drew JM, Aubin ME, et al. Vertebral artery anatomy: a review of two hundred fifty magnetic resonance imaging scans. Spine (Phila Pa 1976). 2010; 35(23): 2035–2040.
  9. Fisher CM, Gore I, Okabe N, et al. Atherosclerosis of the carotid and vertebral arteries: extracranial and intracranial. J Neuropathol Exp Neurol. 1965; 24(3): 455–476.
  10. Flossmann E, Rothwell PM. Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain. 2003; 126(Pt 9): 1940–1954.
  11. Gaigalaite V, Vilimas A, Ozeraitiene V, et al. Association between vertebral artery hypoplasia and posterior circulation stroke. BMC Neurol. 2016; 16: 118.
  12. Grasso G, Alafaci C, Passalacqua M, et al. Landmarks for vertebral artery repositioning in bulbar compression syndrome: anatomic and microsurgical nuances. Neurosurgery. 2005; 56(1 Suppl): 160–164.
  13. Gulli G, Marquardt L, Rothwell PM, et al. Stroke risk after posterior circulation stroke/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies. Stroke. 2013; 44(3): 598–604.
  14. Han HX, Wang JH, Chen XF. Correlation between vertebral artery superiority and posterior circulation infarction. J Integ Trad Chinese Western Med Cardiovasc Cerebrovasc Dis. 2015; 13: 1555–1557.
  15. Hong JM, Chung CS, Bang OY, et al. Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neurosurg Psychiatry. 2009; 80(10): 1087–1092.
  16. Hu XY, Li ZX, Liu HQ, et al. Relationship between vertebral artery hypoplasia and posterior circulation stroke in Chinese patients. Neuroradiology. 2013; 55(3): 291–295.
  17. Jeng JS, Yip PK. Evaluation of vertebral artery hypoplasia and asymmetry by color-coded duplex ultrasonography. Ultrasound Med Biol. 2004; 30(5): 605–609.
  18. Kalia J, Hussain S, Wolfe T, et al. 026 Prevalence of co-dominance in vertebral arteries: a CT angiographic assessment. J NeuroInterven Surg. 2009; 1(1): 98–98.
  19. Kansal R, Mahore A, Dange N, et al. Dolichoectasia of vertebrobasilar arteries as a cause of hydrocephalus. J Neurosci Rural Pract. 2011; 2(1): 62–64.
  20. Katsanos AH, Kosmidou M, Kyritsis AP, et al. Is vertebral artery hypoplasia a predisposing factor for posterior circulation cerebral ischemic events? A comprehensive review. Eur Neurol. 2013; 70(1-2): 78–83.
  21. Lu YJ, Wang YX, LI WJ. The relationship of vertebral artery dominance and vertebrobasilar arterial insufficiency vertigo. Chinese J Neuroimmun Neurol. 2013; 20(4): 253–259.
  22. Matula C, Trattnig S, Tschabitscher M, et al. The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol. 1997; 48(2): 125–131.
  23. Min JH, Lee YS. Transcranial Doppler ultrasonographic evaluation of vertebral artery hypoplasia and aplasia. J Neurol Sci. 2007; 260(1-2): 183–187.
  24. Nouh A, Remke J, Ruland S. Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol. 2014; 5: 30.
  25. Park JH, Kim JM, Roh JK. Hypoplastic vertebral artery: frequency and associations with ischaemic stroke territory. J Neurol Neurosurg Psychiatry. 2007; 78(9): 954–958.
  26. Perren F, Poglia D, Landis T, et al. Vertebral artery hypoplasia: a predisposing factor for posterior circulation stroke? Neurology. 2007; 68(1): 65–67.
  27. Qiu Y, Wu X, Zhuang Z, et al. Anatomical variations of the aortic arch branches in a sample of Chinese cadavers: embryological basis and literature review. Interact Cardiovasc Thorac Surg. 2019; 28(4): 622–628.
  28. Ren BS, Ma YW, Liu YG. Measurement and variation of the outer diameter of the vertebral artery. J Mudanjiang Med Coll. 2013; 34(2): 72–73.
  29. Scheel P, Ruge C, Schöning M. Flow velocity and flow volume measurements in the extracranial carotid and vertebral arteries in healthy adults: reference data and the effects of age. Ultrasound Med Biol. 2000; 26(8): 1261–1266.
  30. Smith AS, Bellon JR. Parallel and spiral flow patterns of vertebral artery contributions to the basilar artery. AJNR Am J Neuroradiol. 1995; 16(8): 1587–1591.
  31. Songur A, Gonul Y, Ozen OA, et al. Variations in the intracranial vertebrobasilar system. Surg Radiol Anat. 2008; 30(3): 257–264.
  32. Tarnoki AD, Fejer B, Tarnoki DL, et al. Vertebral Artery Diameter and Flow: Nature or Nurture. J Neuroimaging. 2017; 27(5): 499–504.
  33. Touboul PJ, Bousser MG, LaPlane D, et al. Duplex scanning of normal vertebral arteries. Stroke. 1986; 17(5): 921–923.
  34. Troutman DA, Bicking GK, Madden NJ, et al. Aberrant origin of left vertebral artery. J Vasc Surg. 2013; 58(6): 1670.
  35. Turan-Ozdemir S, Yıldız C, Cankur NS. Evaluation of vertebral artery system in a healthy population by using colour duplex Doppler ultrasonography. (in Turkish). Uludag Univ Tıp Fak Derg. 2002; 28: 95–99.
  36. Wang J, Guo F, Wang Q, et al. Relationship between Wallenberg syndrome and vertebral artery morphological variation: report of 37 cases. J Third Military Medical University. 2014.
  37. Wang L, Zhang J, Xin S. Morphologic features of the aortic arch and its branches in the adult Chinese population. J Vasc Surg. 2016; 64(6): 1602–1608.e1.
  38. Wang S, Wang C, Liu Yi, et al. Anomalous vertebral artery in craniovertebral junction with occipitalization of the atlas. Spine. 2009; 34(26): 2838–2842.
  39. Wang YQ. Study on the corrdation of vertebral artery dominance and posterior circulation infarct. Chin J Neuroll. 2012;45; 45(7): 490–494.
  40. Xue AQ, Wang W. Anatomical features of the proximal vertebral artery and its clinical significance. J Heze Med Coll. 2002; 22(1): 3–4.
  41. Yokoyama Y, Fujimoto S, Toyoda K, et al. Relationships between vertebral artery diameter and dissecting aneurysm formation. J Cerebral Blood Flow Metab. 2005; 25(Suppl 1): S148.
  42. Yu Y, Xu ZQ, Luo BY. Vertebral artery hypoplasia and posterior circulation ischemic stroke: from hypothesis to pathogenesis. Chin J Stroke. 2014; 9(10): 880–884.
  43. Yuan SM. Aberrant origin of vertebral artery and its clinical implications. Braz J Cardiovasc Surg. 2016; 31(1): 52–59.
  44. Yuan YJ, Xu K, Luo Qi, et al. Research progress on vertebrobasilar dolichoectasia. Int J Med Sci. 2014; 11(10): 1039–1048.
  45. Zhang D, Zhang S, Zhang H, et al. Characteristics of vascular lesions in patients with posterior circulation infarction according to age and region of infarct. Neural Regen Res. 2012; 7(32): 2536–2541.
  46. Zhang DP, Lu GF, Zhang JW, et al. Vertebral artery hypoplasia and posterior circulation infarction in patients with isolated vertigo with stroke risk factors. J Stroke Cerebrovasc Dis. 2017; 26(2): 295–300.
  47. Zhang Q, Guo Y. Clinical status of vertebral artery dysplasia. Chin J Stroke. 2016; 11(4): 318–323.
  48. Zhu W, Wang YF, Dong XF, et al. Study on the correlation of vertebral artery dominance, basilar artery curvature and posterior circulation infarction. Acta Neurol Belg. 2016; 116(3): 287–293.
  49. Zhu X, Xin SJ, Wang L, et al. The relationship of vertebral artery hypoplasia and anomalous origin of vertebral artery. J China Med University. 2015; 44(04): 293–297.
  50. Zhuang YM. Vertebral artery hypoplasia and stroke. Chin J Stroke. 2010; 05(7): 536–538.
  51. Zwiebel WJ. Introduction to vascular ultrasonography, second edition. Grune and Stratton Inc., Orlando, FL 1986: 37.

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