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Delineability and anatomical variations of perforating arteries from normal vertebral artery on 3D DSA: implications for endovascular treatment of dissecting aneurysms

  • Interventional Neuroradiology
  • Published:
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Abstract

Background and Purpose

Endovascular trapping of the vertebral artery dissecting aneurysms (VADAs) carries a risk of medullary infarction due to the occlusion of the perforating arteries. We evaluated the detectability and anatomical variations of perforating arteries arising from the vertebral artery (VA) using three-dimensional DSA.

Methods

In 120 patients without VA lesions who underwent rotational vertebral arteriography, the anatomical configurations of perforating arteries from the VA were retrospectively evaluated on the bi-plane DSA and reconstructed images to reach the consensus between two experienced reviewers. The images were interpreted by focusing on the numbers and types of perforating arteries, the relationships between the number of perforators and the anatomy of the VA and its branches.

Results

Zero, 1, 2, 3, 4, and 6 perforators were detected in 2, 51, 56, 9, 1, and 1 patient, respectively (median of 2 perforators per VA). The 200 perforators were classified into 146 terminal and 54 longitudinal course types and into 32 ventral, 151 lateral, and 17 dorsolateral distribution types. All ventral type perforators were also terminal type. In contrast, the longitudinal type was seen in 28.5% of lateral types and in 65% of dorsolateral types. Regarding the difference in the origin of the posterior inferior cerebellar artery (PICA), non-PICA type VAs gave off larger number of perforators than the other types of VAs.

Conclusions

Non-PICA type VAs give off a significantly larger number of perforators than other types, indicating that the trapping of non-PICA type VAs is associated with a risk of ischemic complications.

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Acknowledgments

The authors would like to thank Dr. Akira Ito (Department of Neuroendovascular Therapy, Kohnan Hospital) for the clinical data collection, and Tomohiro Chiba, Yukiko Jinbo (Radiological technicians, Division of Radiology, Kohnan Hospital), and Naoki Yamamoto (Radiological technician, Diagnostic Imaging Center, Kurume University School of Medicine) for the radiological data collection.

Funding

This study was financially supported by the Japanese Society of Neuroendovascular Therapy.

Author information

Authors and Affiliations

  1. Department of Radiology, Kurume University School of Medicine, Kurume, Japan

    Shuichi Tanoue & Toshi Abe

  2. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan

    Hidenori Endo

  3. Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Masafumi Hiramatsu

  4. Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Yuji Matsumaru & Masayuki Sato

  5. Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan

    Yasushi Matsumoto & Kenichi Sato

  6. Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan

    Wataro Tsuruta

  7. Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan

    Masaru Hirohata

  8. Department of Radiology, Oita University Faculty of Medicine, Oita, Japan

    Hiro Kiyosue

Authors
  1. Shuichi Tanoue
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  2. Hidenori Endo
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  3. Masafumi Hiramatsu
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  4. Yuji Matsumaru
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  9. Masaru Hirohata
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  10. Toshi Abe
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on behalf of the JSNET VADA study group

Corresponding author

Correspondence to Shuichi Tanoue.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Written informed consent was obtained from all patients before procedures; however, the need for informed consent for this study was waived because of the retrospective study design.

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Tanoue, S., Endo, H., Hiramatsu, M. et al. Delineability and anatomical variations of perforating arteries from normal vertebral artery on 3D DSA: implications for endovascular treatment of dissecting aneurysms. Neuroradiology 63, 609–617 (2021). https://doi.org/10.1007/s00234-020-02549-y

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