Vertebral Artery Stenting for Acute Multiple Cerebral Infarctions Caused by Vertebral Artery Dissection After Massage:A Case Report

Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.

Delayed Pseudoaneurysms of Vertebral Artery Post Penetrating Trauma: A Case Report

Objective: Vascular injuries usually present immediately after the penetration, but the delayed onset of vascular symptoms caused by vessel dissection or aneurysm after a traumatic event is extremely rare. Vertebral artery injury is a low-frequency but high-mortality injury. We aim to report evidence of delayed onset of vascular symptoms following penetrating trauma in the neck. Materials and Methods: A case report. Results: A 19-year-old boy was referred to our hospital and complained of a mass in the right part of his neck (right mandibular angle). He gave a history of penetrating trauma to his neck 2 months ago. The mass was expanding during these 2 months and doesn’t respond to antibiotic therapy. In the examination, 3 × 3 cm, firm, nonmobile, and without tenderness and pain mass was palpated in the second level of his neck. Doctors ordered a Doppler sonography in the hospital where a yin-yang pattern was reported. A 36 × 43 × 40 mm heterogeneous, solid, and hypodense area close to C1-C2-C3 with vascular flow was discovered in the right submandibular area after computed tomography (CT)-angiography. The patient was referred to an interventional neurologist for angiography and due to the lack of flow at the distal of the V3 segment, he decided to sacrifice this artery by two coils. Conclusion: Penetrating neck injuries are usually asymptomatic, but these injuries are often accompanied by hemorrhage, neurological symptoms, dysphagia, odynophagia, and windpipe. Penetrating lesions of the vertebral artery are rare and very difficult to diagnose. Also, these lesions are challenging for surgeons due to complex anatomy and difficult surgical exposure. So, endovascular treatment was used to treat the patient.

Comprehensive classifications for the endovascular recanalization of vertebral artery stump syndrome

Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.

Atypical case of bow hunter’s syndrome linked to aberrantly coursing vertebral artery: A case report

BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlantoaxial rather than mid-cervical VA compromise,the latter being rarely reported.Herein,we detail successful VA decompression at mid-cervical spine,given a departure from its usual course.CASE SUMMARY The patient,a 45-year-old man,presented to our hospital with occipital headache and vertigo.Computed tomography angiography showed anomalous C4 entry of right VA,with compression upon head rotation to that side.Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault.We opted for sur-gery,using an anterior cervical approach to remove the anterior tubercle.Patient recovery was uneventful and brought resolution of all preoperative symptoms.CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.

Clinical Efficacy of Acupuncture Combined with Massage on Cervical Spondylopathy of Vertebral Artery Type and Its Effect on Hemodynamics of Patients

Objective:To investigate the clinical efficacy of acupuncture combined with massage on cervical spondylopathy of vertebral artery type and its effect on hemodynamics of patients.Methods:Sixty patients with vertebral artery type cervical spondylosis treated in our hospital from July 2017 to October 2019 were selected as the research subjects and randomly divided into 2 groups of 30 cases each.The control group was treated with acupuncture,and the observation group was treated with acupuncture combined with massage,and the clinical efficacy and hemodynamic index of the two groups were compared after 1 month of treatment[peak systolic blood velocity(PSV),pulsatile index(PI),time mean flow velocity(TMFV)].Results:There was no statistical difference in the PSV,PI,and TMFV between the two groups before treatment(P>0.05).After treatment,the observation group had a higher treatment efficacy than the control group with PSV and TMFV increasing and PI decreasing in both groups,and the change in the observation group was greater than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Acupuncture combined with massage on cervical spondylopathy of vertebral artery type can improve the clinical efficacy and improve the hemodynamic index of patients,which is worthy of clinical application.

EFFECT OF ACUPUNCTURE ON BLOOD FLOW OF VERTEBRAL AND BASILAR ARTERIES IN STROKE PATIENTS

Objective: To observe the short-term effect and long-term effect of acupuncture on blood flow of vertebral and basilar arteries in stroke patients. Methods: A total of 58 stroke patients (34 males and 24 females) were agreed to participate in this study, and changes of blood flow of the vertebral and basilar arteries were detected after one week’s and 45 days’ continuous acupuncture treatment by using a Doppler’s ultrasonic diagnosis apparatus. Bilateral Fengchi (GB 20), Wangu (GB 12), Tianzhu (BL 10), etc. were punctured and stimulated with small amplitude, high frequency and twirling-reinforcing method for 3 min. The treatment was conducted once daily. Results: Following one week’s and 45 days’ acupuncture treatment, diastolic velocity (DV), systolic velocity (SV) and mean velocity (MV) of the basilar artery increased significantly in comparison with pre-treatment (P<0.05～0.01). After one week’s acupuncture treatment, DV, SV and MV of the vertebral artery on the affected side of the brain and after 45 days’ treatment, DV, SV and MV of the vertebral artery on the bilateral sides of the brain all increased considerably compared with their individual basic levels of pre-treatment (P<0.05～0.01). No significant differences were found between pre-treatment and post-treatment in pulse index (PI) of the basilar artery and bilateral vertebral arteries (P> 0.05). Results indicated that acupuncture treatment could effectively improve blood supply of the basilar artery and regulate the uneven blood flow of the bilateral vertebral arteries. Conclusion: Acupuncture treatment can raise blood flow of the brain in stroke patients.

Clinical Efficacy of Modified Erchen Decoction on Cervical Spondylotic Vertebral Arteriopathy with Stagnation and Blockade of Phlegm-dampness Syndrome and Effects on Cerebral Blood Flow Parameters

OBJECTIVE: To observe the effect of Modified Erchen Decoction on cervical spondylotic vertebral arteriopathy with stagnation and blockade of phlegm-dampness syndrome and effects on cerebral blood flow parameters. METHODS: A total of 80 cervical spondylotic vertebral arteriopathy(CSA) patients with stagnation and blockade of phlegmdampness syndrome admitted to our hospital from October 2016 to April 2017 were selected and randomly divided into observation group and control group, with 40 cases in each group. The observation group was treated with Modified Erchen Decoction and the control group was given conventional treatment with Western medicine. After 4 weeks of treatment, the main clinical symptoms and signs(vertigo, neck and shoulder pain, headache, psychological and social adjustment, daily life and work) and cerebral blood flow parameters [the peak values of intracranial vertebral-basal artery diastolic blood flow velocity(Vd) and systolic blood flow velocity(Vp)] were compared between the 2 groups. The total clinical effective rate and adverse reactions during treatment were also compared. RESULTS: After treatment, the total effective rate of the observation group was 90.0%, which was significantly higher than that of the control group(77.5%). The difference between the two groups was statistically significant(P < 0.05). After treatment, The scores of vertigo, neck and shoulder pain, headache, psychology and society adaptation, daily life and work were significantly increased(P < 0.05), and the above scores of the observation group were increased more obviously. The difference between the groups was statistically significant(P < 0.05). After treatment, the levels of Vd and Vp were significantly increased(P < 0.05), and the increase of the above indexes was more obvious in the observation group. The difference between the 2 groups was statistically significant(P < 0.05). There were no significant abnormalities in blood routine, urine routine, liver function and renal function. There was no significant difference in the incidence of adverse reactions between the 2 groups.(P > 0.05). CONCLUSION: The treatment of vertebral artery type cervical spondylopathy with stagnation and blockade of phlegm-dampness syndrome by Modified Erchen Decoction can effectively relieve the main clinical symptoms and signs, improve cerebral blood flow parameters, and improve the peak values of vertebral-basal artery diastolic blood flow velocity(Vd) and systolic blood flow velocity(Vp), which is safe and effective, and helps to promote the recovery of cervical function.

Hemodynamic evaluation of contralateral vertebral artery in patients with subclavian steal syndrome by carotid ultrasound

Objective:To investigate the ultrasonographic characteristics of the hemodynamic changes of the contralateral vertebral artery(VA)in patients with different types of subclavian steal syndrome(SSS).Methods:A total of 152 cases of SSS diagnosed by carotid Doppler ultrasonography(CDU)and confirmed by CT angiography(CTA)were enrolled as the study group.The 152 cases of SSS were divided into type Ⅰ(47 cases of occult steal blood),type Ⅱ(60 cases of partial steal blood)and type Ⅲ(45 cases of complete steal blood).Meanwhile,46 cases of cardiovascular and cerebrovascular diseases were excluded from the health examination center as the control group.The diameter and hemodynamic changes of VA in healthy side of patients with different types of steal blood were analyzed and compared with the control group.Results:The hemodynamic parameters of VA on the contralateral side of three types of SSS in the study group were compared with those in the control group,there was no significant difference between type Ⅰ and the control group(P>0.05),and there was significant difference between type Ⅱ and type Ⅲ and the control group(P<0.05);The diameter and hemodynamic parameters of VA increased with the severity of steal blood(P<0.05).Conclusion:CDU examination of VA hemodynamic parameters in healthy side of SSS patients can be used to preliminarily evaluate SA lesions and VA-VA steal pathway.

Cervical Spondylopathy Involving the Vertebral Arteries Treated by Body-Acupuncture Combined with Scalp-Acupuncture in 72 Cases

Among various types of cervical spondylopathy, the one involving the vertebral arteries is frequently encountered in the middle-aged and the old people. It is often accompanied with arteriosclerosis and high blood viscosity, and clinically it is difficult to be treated. From March 1996 to December 2000, the authors hadtreated 72 cases of cervical spondylopathy of this type and achieved satisfactory therapeutic effects shown by clinical symptoms and indicated by the trans-cranial Doppler ultrasonic examination (TCD). This is reported as follows. ……

TREATMENT OF VERTEBRAL－ARTERY TYPE CERVICAL SPONDYLOPATHY WITH NEEDLE－KNIFE THERAPY

In the present paper, 62 cases of vertebral artery type cervical spondylopathy were treated with needle knife therapy (acupotomy). After 2-6 sessions of treatment, 23 cases (37.1%) were cured, 19 (30.7%) showed marked improvement, 15 (24.2%) had some improvement and 5 (8.1%) failed in the treatment. The total effective rate was 91.9%. It indicates that acupotomy therapy is a highly effective remedy for treating vertebral artery type cervical spndylopathy.

经颅多普勒超声微栓子监测评估PAS治疗颈动脉颈段易损斑块疗效的观察

目的探讨经颅多普勒超声(TCD)微栓子监测评估PAS(抗氧化、抗血小板、调脂治疗)治疗颈动脉颈段易损斑块的疗效。方法收集中国人民解放军联勤保障部队第九一〇医院2019年7月至2021年7月收治的采用PAS疗法进行治疗的颈动脉颈段易损斑块患者作为研究组(46例)。选取2015年6月至2019年6月该院收治的仅采用AS疗法(抗血小板、调脂治疗)治疗的颈动脉颈段易损斑块患者作为对照组(38例)。对2组患者治疗前后进行TCD微栓子监测,并评估斑块稳定性。结果治疗后研究组共检测出微栓子信号(MES)阳性患者1例,对照组共检测出MES阳性患者6例(P<0.05)。治疗后颈动脉内膜中层厚度(IMT)研究组低于对照组(P<0.05)。研究组治疗后IMT明显低于治疗前(P<0.05),对照组治疗前后IMT无明显变化(P>0.05)。随访1年,研究组缺血事件发生率显著低于对照组(P<0.05),且发生急性脑梗死患者的卒中严重程度轻于对照组(P<0.05)。研究组出现3例消化系统不良反应,不影响治疗及预后。结论PAS治疗颈动脉颈段易损斑块,有助于提高斑块稳定性,可以降低卒中发生风险,减轻卒中严重程度。

Vertebral Artery Dissection Probably Caused by Massage: A Case Report

MASSAGE has been recommended to more people as an adjunct to health care. We illustrate a case of vertebral artery dissection(VAD) probably caused by massage that almost resulted in the patient's death. The patient experienced sudden cardiac arrest and paralysis. After treatment with anticoagulation and antiplatelet, he finally discharged without any sequelae.

Endovascular treatment of extracranial vertebral artery stenosis

Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.

Assessing the Validity of a Novel Model of Vertebral Artery Type of Cervical Syndrome Induced by Injecting Sclerosing Agent Next to Transverse Process of Cervical Vertebra

The efficacy of injecting sclerosing agent next to transverse process of cervical vertebra to induce vertebral artery type of cervical syndrome(CSA)was observed.Twenty rabbits were randomly divided into two groups:the model group and the control group.The rabbits in the model group were injected with sclerosing agent next to transverse process of cervical vertebray,on the contrary,the rabbits in the control group were injected with nothing.Transcranial Doppler(TCD)was used to detect the average speed of blo...

Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging

Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso- nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat- ment only. The intervention group received vertebral artery orifice angioplasty and stenting ＋ identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

Reconstructive treatment of symptomatic vertebral artery dissecting aneurysms with Willis covered stent: Initial experience

Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive treatment have not been well established.Objective:To evaluate the safety and efficacy of reconstructive endovascular treatment(EVT)for symptomatic VADAs with Willis covered stent.Methods:We evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent,compared with stent-assisted coiling(SAC)on the characteristics,posttreatment course,angiographic and clinical follow-up outcomes at an average of 14.4 months(range,3-48 months).Results:A total of 33 patients with symptomatic VADAs were reviewed,23 of these patients with ruptured VADAs.The technical successful rate is 100%respectively in Willis covered stent(Group A)and SAC(Group B,n=20).The initial complete occlusion rate was significant higher in group A(100%)than group B(30%)(p<0.01).Major procedure-related complications were not significant different in the two groups.Serial follow-up angiograms revealed 5 recurrent VADAs in group B and no recurrence in group A(p>0.05).No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period.The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A(100%)than group B(80%),but no significant statistical difference(p>0.05).Clinical outcomes were favorable in 31(93.9%),severe disability occurred in one in group B,and only one death in group A.The final clinical outcomes were also not significant difference in the two groups(p>0.05).Conclusions:Our initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments,which is similar to favorable results with SAC.However,an expanded clinical experiences and larger cohort studies are needed.

Spontaneous Extracranial Vertebral Artery Dissociation: A Case Report and Review of the Literature

We encountered a 36-year-old female who developed extracranial vertebral artery dissociation (EVAD), which is a rare condition in Japan. The disease developed with sudden severe right side neck pain and right upper arm pain. No abnormality was observed in the spinal canal, intervertebral discs, spinal cord, or nerve roots on MRI of the cervical spine, but dilation and double lumen were noted in the vertebral artery (VA) at the C4/5 level. The presence of aneurysm was confirmed by VA angiography, and EVAD was diagnosed. The symptoms were resolved by conservative treatment of pain, and the aneurysm shrank and disappeared with time on VA angiography. Even though neck and upper limb pain are the only clinical symptom and there is no brain dysfunction, such as disturbance of consciousness and vertigo, when symptoms develop acutely, this pathology should be included in differential diagnosis and orthopedists should carefully observe the vertebral artery, as well as the spinal canal, in evaluating cervical MRI.

Acupuncture-based treatments on cervical spondylosis of vertebral artery type

Cervical spondylosis of vertebral artery type is one of the chief patterns of cervical spondylosis.It is often described as neck pain accompanied with radiating pain and neurologic symptoms,such as sudden dizziness,blurred vision,tinnitus,nausea,vomiting,memory loss,and sudden fainting.The incidence of cervical spondylosis increases and patients with cervical spondylosis become progressively younger.Acupuncture in the cervical spondylosis of vertebral artery type treatment has a local positive reaction“Liuhe point”,in order to dredge the local Qi and blood.More and more evidences into the effectiveness and safety of cervical spine acupuncture for cervical spondylosis,specific neck pain,cervical radiculopathy,etc.This article summarizes the recent literature on acupuncture and acupuncture combined with other therapies for cervical spondylosis of vertebral artery type treatment and provides a comprehensive review from the perspectives of acupuncture therapy,warm needle moxibustion therapy,electroacupuncture,and acupuncture combined with other therapies,in order to provide reference and reference for clinical treatment.

THE CHANGE AND SIGNIFICANCE OF ENDOTHELIN IN SERUM OF VERTEBRAL ARTERIAL INSUFFICIENCY TYPE ERVICAL SPONDYLOSIS

we studied 30 vertebral arterial insufficiency type cervical spondylosis patients and 30sex and age matched healthy controls by detecting their serum endothelin (ET) levels with radioimmuuoassay (RIA).At the same time, we selected 20 severe patients for operation therapy,and compared their serum ET levels before and after operation.The results showed that 30 patients had higher ET levels [(119. 46±58.65)ng/L] than those of the controls [(38. 43±14.33)ng/L], and the 20 patients had higher ET levels before operation [(139. 34±52. 56)ng/L] than after operation [(50.84±21. 67)ng/L)].Both have statistical significance (P<0.001 ).Therefore, we think that serum ET is one or important humoral factors contributing to vertebral arterial insufficiency type cervical spondylosis.It may be useful in treating verteibral arterial insufficiency type cervical spondylosis with effective ET-antibody, inhibitor or ET converting enzyme and special ET receptor blocker.

Catastrophic vertebral artery and subclavian artery pseudoaneurysms caused by a fishbone:A case report

BACKGROUND Fishbone is the most common esophageal foreign body and tends to migrate after piercing the esophagus to nearby structures.Vascular injury around the esophagus is a serious complication and has a high mortality rate,especially in the case of multiple vascular injuries.CASE SUMMARY We report an extremely rare case of successive vertebral artery and subclavian artery pseudoaneurysms caused by swallowing a fishbone in a previously healthy 29-year-old female.She was transferred to the emergency department of our hospital because of hemorrhagic shock due to a vertebral artery pseudoaneurysm.We successfully managed the vertebral artery pseudoaneurysm with endovascular stent implantation and the patient's vital signs as well as hemodynamics once became stable.However,the patient died of the second subclavian artery pseudoaneurysm occurring within a short time,which was thought be related to the obvious displacement of the fishbone in the mediastinum.CONCLUSION Surgery and endovascular stent implantation may be the best choice for treating such complications.Early removal of the fishbone is of great significance in improving the survival of such patients.