Article Figures & Data
Figures
- Fig 1.
Left vertebral angiograms in anteroposterior (A and C) and lateral (B and D) views show the occluded vertebral artery (VA) and retrograde upward flow through the anterior spinal artery (ASA) at early arterial (A and B) and later (C and D) phases in patient 1. The ASA is connected to the right distal VA and supplies the right anterior and posterior inferior cerebellar arteries.
- Fig 2.
Left vertebral angiograms in anteroposterior (AP) (A) and lateral (B) views show the anterior spinal artery (ASA; arrow) filled in retrograde direction as well as the occluded VA in patient 3, though it is not clear that the ASA is providing any significant collateral support to the posterior circulation. Left common carotid angiograms in AP (C) and lateral (D) views reveal contrast filling of the basilar artery from the posterior communicating artery. Diffuse severe arteriosclerotic narrowing and dilation of cerebral arteries is also noted.
- Fig 3.
Right vertebral angiograms in lateral views (A and B) demonstrate the occluded vertebral artery (VA) and retrograde flow through the anterior spinal artery (ASA) and perfusion to pontine perforators after filling of the basilar artery at later phase (B, arrow) in patient 2. Angiograms in right anterior oblique view at early arterial (C) and later (D) phases reveals reversal (normalization) of blood flow through the ASA after successful stent-assisted recanalization of the right VA.
- Fig 4.
Irregular stenosis of the left vertebral artery (VA) is shown on the left vertebral angiograms in anteroposterior (AP) (A) and lateral (B) views in patient 5. Severe stenosis of the left posterior inferior cerebral artery (PICA) orifice is also noted (arrow). Right vertebral angiogram in the lateral view shows retrograde flow through the anterior spinal artery (ASA) (C). There is minimal perfusion to right distal VA. Follow-up angiography after 9 months shows increased perfusion through the ASA at early arterial (D) and later (E) phases. Both distal VAs are connected to the ASA, and perfusion to the common trunk of the right anterior interior cerebellar artery (AICA) and PICA and left AICA is maintained by this collateral route. The left VA was completely occluded (not shown).
Tables
No/Gender/Age Presentation Acute Ischemic Lesions on MRI Extent of Parenchymal Lesions Interventional Procedure mRS at Discharge 1/F/62 Dizziness, gait disturbance L pons, both CH Focal IA thrombolysis w/ stent-assisted angioplasty 3 2/M/64 R hemiparesis, R facial palsy R midbrain, L CH, R occipital lobe Focal IA thrombolysis w/ stent-assisted angioplasty 2 3/F/75 L hemiplegia, L facial palsy, dysphagia R pons, both CH Focal NA 4 4/F/63 Dizziness, gait ataxia R CH Focal Stent-assisted angioplasty 1 5/M/40 Dizziness, gait ataxia L CH Territorial NA 2 6/M/81 Quadriparesis, aphagia L midbrain, L pons, L CH Territorial IA thrombolysis w/ stent-assisted angioplasty 4 Note:—MRI indicates MR imaging; mRS, modified Rankin scale; CH, cerebellar hemisphere; IA, intra-arterial; R, right; L, left; NA, not attempted.
No Right VA Left VA Course of ASA Perfusion via ASA Collateral Supply from PcomA VBJ Patency Comment 1 Occlusion Occlusion L VA → R VA R AICA & PICA Both SCAs filling from L PcomA Yes Reversed flow of ASA disappeared after recanalization; reappearance of ASA 2 Occlusion Severe stenosis R VA → L VA Part of BA Nil Yes BA filling from L VA; reversal of ASA flow direction after recanalization 3 Occlusion Occlusion L VA → R VA Not profuse BA trunk filling from L PcomA No 4 Severe stenosis Occlusion R & L VA → L VA Not profuse Both SCAs filling from R PcomA Yes Reversal of ASA flow direction after recanalization 5 Occlusion Occlusion R VA → both VAs R AICA & PICA; L AICA Nil Yes Increased perfusion through ASA after occlusion of L VA 6 Occlusion Severe stenosis R VA → R VA Not profuse Nil Yes Reversal of ASA flow direction after recanalization Note:—VA, vertebral artery; ASA, anterior spinal artery; PcomA, posterior communicating artery; VBJ, vertebrobasilar junction; L, left; R, right; AICA, anterior inferior cerebellar artery; PICA, posterior inferior cerebellar artery; SCA, superior cerebellar artery; BA, basilar artery.
