BACKGROUND AND IMPORTANCE: Extracranial-intracranial bypass remains an enduring procedure for a select group of patients suffering from steno-occlusive cerebrovascular disease. Although the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is most familiar among neurosurgeons, particular circumstances preclude the use of an STA donor. In such cases, alternative revascularization strategies must be pursued. CLINICAL PRESENTATION: A 63-year-old female presented with symptoms of hemodynamic insufficiency and was found to have left common carotid artery occlusion at the origin. She experienced progressive watershed ischemia and pressure-dependent fluctuations in her neurological examination despite maximum medical therapy. The ipsilateral STA was unsuitable for use as a donor vessel. We performed an extracranial vertebral artery (VA) to MCA bypass with a radial artery interposition graft. CONCLUSION: This technical case description and accompanying surgical video review the relevant anatomy and surgical technique for a VA-MCA bypass. The patient was ultimately discharged home at her preoperative neurological baseline with patency of the bypass. The VA can serve as a useful donor vessel for cerebral revascularization procedures in pathologies ranging from malignancies of the head and neck to cerebral aneurysms and cerebrovascular steno-occlusive disease.

• MeSH
• Carotid Artery, Internal surgery   MeSH
• Middle Cerebral Artery diagnostic imaging   surgery   MeSH
• Vertebral Artery diagnostic imaging   surgery   MeSH
• Cerebrovascular Disorders * surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Cerebral Revascularization * methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

PURPOSE: Stroke, the second leading cause of death globally, often involves ischemia in the vertebrobasilar territory. This condition is underexplored, despite significant morbidity and mortality risks. The purpose of this study is to present a case of occipital artery to V3 segment vertebral artery bypass, emphasizing the role of quantitative magnetic resonance angiography (qMRA) in assessing flow and guiding surgical intervention. METHODS: A 66-year-old man with bilateral vertebral artery occlusion presented acute symptoms. qMRA was employed to evaluate flow dynamics and determine the feasibility of a flow augmentation bypass surgery. The occipital artery to left vertebral artery bypass (OA-to-VA) was performed, utilizing an inverted hockey-stick incision and an antegrade inside-out technique. The patency of the bypass was confirmed using both Doppler probe and Indocyanine green. RESULTS: Postoperative assessments, including computed tomography angiography (CTA) and qMRA, demonstrated the patency of the bypass with improved flow in the basilar artery and left vertebral artery. The patient's condition remained stable postoperatively, with residual peripheral palsy of the left facial nerve. CONCLUSION: In conclusion, the presented case illustrates the efficacy of the OA-to-VA bypass in addressing symptomatic bilateral vertebral artery occlusion. The study underscores the pivotal role of qMRA in pre- and postoperative assessments, providing noninvasive flow quantification for diagnostic considerations and long-term follow-up in patients with vertebrobasilar insufficiency.

• MeSH
• Vertebral Artery * surgery   diagnostic imaging   MeSH
• Humans MeSH
• Magnetic Resonance Angiography * methods   MeSH
• Cerebral Revascularization * methods   MeSH
• Aged MeSH
• Vertebrobasilar Insufficiency * surgery   diagnostic imaging   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

• MeSH
• Vertebral Artery diagnostic imaging   MeSH
• Carotid Arteries diagnostic imaging   MeSH
• Cerebral Arteries diagnostic imaging   MeSH
• Cerebrovascular Disorders diagnostic imaging   MeSH
• Diagnostic Imaging classification   methods   MeSH
• Humans MeSH
• Brain diagnostic imaging   MeSH
• Neurologic Examination classification   methods   instrumentation   MeSH
• Ultrasonography, Doppler, Transcranial methods   MeSH
• Ultrasonography * classification   methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Předkládaná kazuistika pojednává o pacientce s již diagnostikovanou autoimunitní hepati-tidou, klinicky vyjádřeným sekundárním Sjögrenovým syndromem, aneuryzmatem verte-brální arterie a ektázií vnitřní karotické arterie. Kazuistika popisuje algoritmus postupné dia-gnostiky vzácné autoimunitní mozaiky mladé ženy a diferenciálně diagnostický rozbor.

In this case, a female patient has been already diagnosed with an autoimmune hepatitis, withsecondary Sjögren's syndrome symptoms, aneurysm of vertebral arteries and ectasia of arteriacarotis interna. This case report reveals an algorithm of gradual diagnosis of this rare autoim-mune mosaic in a young woman, and its differential diagnostic analysis.

• MeSH
• Aortic Aneurysm diagnostic imaging   MeSH
• Vertebral Artery diagnostic imaging   pathology   MeSH
• Hepatitis, Autoimmune * diagnostic imaging   complications   MeSH
• Diagnosis, Differential MeSH
• Adult MeSH
• Comorbidity MeSH
• Humans MeSH
• Antibodies, Antineutrophil Cytoplasmic blood   MeSH
• Sjogren's Syndrome classification   blood   pathology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Manipulačná liečba algických syndrómov krčnej chrbtice, vykonávaná nielen lekármi, ale aj inými zdravotníckymi pracovníkmi, je stále viac vyhľadávaná pacientmi ako alternatíva medikamentóznej liečby. I manipulačná liečba má však riziká. Jednou z najčastejšie popisovaných komplikácií v literatúre je vznik disekcie vertebrálnej artérie často končiacej jej oklúziou. Práca podáva literárny prehľad anatomických podmienok a možných mechanizmov vedúcich počas liečebnej manipulácie krčnej chrbtice k disekcii jednej z vertebrálnych artérií. Zároveň uvádza prehľad diagnostických možnosti s dôrazom na dostupnosť a špecifiká ultrasonografickej diagnostiky oklúzií vertebrálnych arterií. V závere sa práca venuje niektorým odporúčaniam zameraným na zníženie rizika možného vzniku poškodenia krčných artérií.

Manipulation therapy of aching syndromes of vertebral column performed by physicians or other medical personnel, is increasingly sought by patients as an alternative of medicament therapy. Even the manipulation treatment is not without risk. One of the most often reported complications in literature is the development of dissection of vertebral artery, frequently resulting in occlusion. The contribution reviews literature about anatomical conditions and possible mechanisms during therapeutic manipulation of cervical spine resulting in dissection of one of vertebral arteries. Moreover, the author presents the survey of diagnostic possibilities with emphasis to availability and specific features of ultrasound diagnostic od vertebral artery occlusion. In conclusion the contribution deals with some recommendations paying attention to a decrease of the risk of possible origin of arterial artery damage.

• MeSH
• Vertebral Artery diagnostic imaging   pathology   MeSH
• Vertebral Artery Dissection * diagnostic imaging   etiology   MeSH
• Cervical Vertebrae pathology   MeSH
• Humans MeSH
• Manipulation, Chiropractic * adverse effects   MeSH
• Ultrasonography methods   MeSH
• Check Tag
• Humans MeSH

OBJECTIVE: The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants. METHODS: A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed. RESULTS: A total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations. CONCLUSIONS: Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.

• MeSH
• Aneurysm diagnostic imaging   epidemiology   MeSH
• Aorta, Thoracic abnormalities   diagnostic imaging   MeSH
• Subclavian Artery abnormalities   diagnostic imaging   MeSH
• Vertebral Artery abnormalities   diagnostic imaging   MeSH
• Carotid Arteries abnormalities   diagnostic imaging   MeSH
• Black People MeSH
• Incidence MeSH
• Cardiovascular Abnormalities diagnostic imaging   epidemiology   MeSH
• Humans MeSH
• Prevalence MeSH
• Prognosis MeSH
• Brachiocephalic Trunk abnormalities   diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

• MeSH
• Vertebral Artery diagnostic imaging   MeSH
• Vertebral Artery Dissection diagnostic imaging   MeSH
• Adult MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Imaging, Three-Dimensional methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

Úvod: Poranenia krčných tepien sú imanentným javom pri poraneniach krčnej chrbtice. Metóda: Prospektívna dvojkohortová štúdia od októbra 2013 do októbra 2015. Celkovo sme vyšetrili 76 pacientov (39Ž/37M) s vekovým mediánom 77 rokov pri fraktúrach alebo diskoligamentárnych poraneniach skeletu, a to pomocou duplexnej sonografie a/alebo CT - angiografie. K tomu bolo pomocou rovnakých modalít v období od októbra 2013 do októbra 2017 vyšetrených 155 pacientov s distorziou krčnej chrbtice (49 % žien a 51 % mužov), s priemerným vekom 39 rokov, SD 19 a vekovým mediánom 34 rokov. Štatistické vyhodnotenie sme realizovali v programe Bias 11.01. Výsledok: Celková incidencia poranenia a. carotis interna predstavovala 2,5 %, z toho u 50 % (1,2 %) s neurologickou symptomatikou. Pre poranenia vertebrálnych artérií sme zistili pomerne vysokú incidenciu 10,5 %, u 25 % (2,6 %) s neurologickou symptomatológiou. Spondylofyty a stupeň dislokácie boli identifikované ako rizikové faktory u fraktúr a diskoligamentárnych poranení. Predilekčným miestom poranenia ciev sa v týchto prípadoch javia vertebrálny kanál a oblasť blízko bázy lebečnej. V skupine distorzií sme nenašli ani jedno poranenie krčných tepien. Predilekčným miestom kolaterálnych poranení bola v týchto prípadoch opätovne oblasť spondylofytárnych zmien. Záver: V prípade relevantného poranenia krčnej chrbtice je nevyhnutná diagnostika príslušných ciev a naopak, v prípade ich poranenia treba vychádzať skôr zo závažného poškodenia skeletu.

Introduction: Cervical spine injuries are immanently accompanied by trauma to cerebral neck arteries. Method: A prospective two-cohort study, from oct. 2013 to oct. 2015. Overall 76 Patients (39W/37M) of median age 77 years, with either fractures or discoligamentary injuries have been examined with duplex-sonography and or CT-angiography. From October 2013 to October 2017 we examined 155 Patients (49% female and 51% male), with the average age of 39 years, SD 19 and age median of 34 years, with cervical-spine-distortion, using the same diagnostic modalities. We used the statistics-program Bias 11.01. Results: The overall incidence of traumatic dissection of the internal carotid artery was 2.5%, in 50% of cases (1.2%) with neurological symptomatology. For the vertebral artery seems the incidence of 10.5%, with 25% of symptomatic patients (2.6%) comparably high. We have identified the osteophytes and dislocation as the significant risk factors. The canalis vertebralis and the skull-base are regions mostly prone to vascular injury. In the group of cervical spine distorsions we found no vascular trauma at all. The osteophytes were here identified as the main risk factor for collateral damage. Conclusion: One should look for vascular injuries in case of cervical relevant spine trauma. Moreover, a rather relevant osteoligamentous injury should be assumed, when cervical vascular trauma was diagnosed.

• MeSH
• Vertebral Artery diagnostic imaging   pathology   injuries   MeSH
• Computed Tomography Angiography MeSH
• Aortic Dissection diagnosis   pathology   MeSH
• Ultrasonography, Doppler, Duplex MeSH
• Incidence MeSH
• Cohort Studies MeSH
• Cervical Vertebrae * diagnostic imaging   injuries   MeSH
• Humans MeSH
• Carotid Artery Injuries * pathology   MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Check Tag
• Humans MeSH

There are numerous indications for stabilization using instrumentation of the upper cervical spine. This area is comprised of sophisticated anatomy. There is no study describing bony and vascular anomalies of this area in the middle European population. The main aim of this study was to investigate prevalence of any vertebral artery (VA) variations and osseous anomalies in the region of the craniocervical junction in a large sample of Czech patients based on three-dimensional computed tomographic angiography (3D CTA). The VA has a variable course through C2 before it passes above its groove on the posterior arch of C1. The artery can course more medially, more posteriorly or more superiorly, thus limiting the diameter of the bony elements used as landmarks for the safe insertion of metalwork. This is known as a high-riding VA (HRVA). The VA was considered HRVA in this study if the thickness of the C2 isthmus was less than 5 mm and/or the C2 internal height was less than 2 mm and/or the width of the C2 pedicle was less than 4 mm. The prevalence of ponticulus posticus (PP) was also identified. Following the VA variations in the V3 segment of the artery were persistent first intersegmental artery (FIA), fenestration (FEN) of the VA, and the posterior inferior cerebellar artery (PICA) branch originating from the C1/2 part of VA. Records of 511 patients from our institution were analyzed. The mean age of the patients was 63.6 years. One hundred and twenty-three (24.1 %) patients were identified to have HRVA, 30 (6 %) present on both sides. The age of patient over 70 years and female sex were found to be significant risk factors for HRVA presence. The prevalence of a nearby PICA branch was 4 %, FIA was 0.4 %, and FEN was 0.2 %. The presence of PP was identified in 14.3 % of patients. The HRVA and PP are common anomalies in the Czech population, and routine preoperative high-resolution CT evaluation is mandatory to prevent the VA injury when C1-C2 instrumentation is planned. The female sex and age over 70 years were found to be the most important factors for HRVA presence. The FIA and the FEN VA were rare in our study contrary to reports published from Asia, showing as many as a 10 % the VA presence over the starting point for C1 lateral screw. On the basis of the infrequent occurrence of these anomalies, we do not recommend routine CT angiography when upper cervical spine instrumentation in the normal population is planned.

• MeSH
• Vertebral Artery diagnostic imaging   surgery   MeSH
• Cervical Atlas diagnostic imaging   surgery   MeSH
• Computed Tomography Angiography MeSH
• Adult MeSH
• Bone and Bones diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Cerebral Angiography MeSH
• Neurosurgical Procedures MeSH
• Image Processing, Computer-Assisted MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

18 F-FDG PET/CT imaging is useful in patients with fever of unknown origin and can detect giant cell arteritis in extracranial large arteries. However, it is usually assumed that temporal arteries cannot be visualized with a PET/CT scanner due to their small diameter. Three patients with clinical symptoms of temporal arteritis were examined using a standard whole body PET/CT protocol (skull base - mid thighs) followed by a head PET/CT scan using the brain protocol. High18F-FDG uptake in the aorta and some arterial branches were detected in all 3 patients with the whole body protocol. Using the brain protocol, head imaging led to detection of high18F-FDG uptake in temporal arteries as well as in their branches (3 patients), in occipital arteries (2 patients) and also in vertebral arteries (3 patients).

• MeSH
• Vertebral Artery diagnostic imaging   metabolism   MeSH
• Temporal Arteries diagnostic imaging   metabolism   MeSH
• Fluorodeoxyglucose F18 * pharmacokinetics   MeSH
• Middle Aged MeSH
• Humans MeSH
• Giant Cell Arteritis diagnostic imaging   MeSH
• Positron Emission Tomography Computed Tomography * MeSH
• Radiopharmaceuticals * pharmacokinetics   MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH